Disclosure of Patient Protections Against Balance Billing (No Surprises Act)

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgery center, you are protected from balance billing (also called “surprise billing”).

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. If a provider or facility is out-of-network, you may be billed the difference between what your plan pays and the full billed charge – this is called balance billing.

Your protections under federal law (No Surprises Act)

You cannot be balance billed for:

  1. Emergency services
–If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility, you can only be billed for your in-network cost-sharing amount (copay/coinsurance/deductible), as determined by your health plan.
  2. Certain non-emergency services at an in-network facility (like an ambulatory surgery center)—
If you receive services at an in-network facility, certain providers involved in your care may be out-of-network (for example, anesthesia or other facility-based professional services). In many of these situations, you are protected and generally should not be billed more than your in-network cost-sharing amount.
  3. Air ambulance services (but not ground ambulance)
—You are protected from balance billing for out-of-network air ambulance services. (These federal protections generally do not apply to ground ambulance services.)

When can you be asked to waive these protections?

In certain non-emergency situations, an out-of-network provider may ask you to sign a notice and consent form to give up these balance-billing protections for specific services. You are not required to sign, and you can ask for an in-network provider when available. These waivers are not permitted for emergency care.

If you think you’ve been wrongly balance billed

Federal help and complaints (No Surprises Help Desk): 
Call 1-800-985-3059 to ask questions or submit a complaint.)

Texas help and complaints (Texas Department of Insurance): 
If you have coverage subject to Texas surprise-billing protections, you can contact the Texas Department of Insurance at 1-800-252-3439 and review Texas surprise medical billing resources through TDI’s medical billing/surprise billing webpages. TDI also provides provider-facing resources and an IDR contact email (IDR@tdi.texas.gov) for Texas processes.

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If you have questions about a bill from Vertex Surgery Center, please contact:

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