Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance, and/or deductible.

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, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn't in your health plan's network.

"Out-of-network" means providers and facilities that haven't signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called "balance billing." This amount is likely more than in-network costs for the same service and might not count toward your plan's deductible or annual out-of-pocket limit.

"Surprise billing" is an unexpected balance bill. This can happen when you can't control who is involved in your care — like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You're protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan's in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can't be balance billed for these emergency services. This includes services you may get after you're in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan's in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can't balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections.

You're never required to give up your protections from balance billing. You also aren't required to get out-of-network care. You can choose a provider or facility in your plan's network.

New Jersey State Protections

New Jersey's Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (effective August 30, 2018) provides additional protections against surprise billing for residents covered under fully insured plans, the State Health Benefits plans, and self-funded plans that have opted in. Under this law, health care providers are prohibited from balance billing patients for inadvertent out-of-network services and services provided on an emergency or urgent basis. For more information about your rights under New Jersey law, visit the New Jersey Department of Banking and Insurance at nj.gov/dobi.

When balance billing isn't allowed, you also have these protections:

• You're only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

• Your health plan must cover emergency services without requiring you to get approval for services in advance (also known as "prior authorization").

• Your health plan must cover emergency services by out-of-network providers.

• Your health plan must base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.

• Your health plan must count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

Good Faith Estimates for Uninsured or Self-Pay Patients

If you are uninsured or choose not to use your health insurance for a service, you have the right to receive a Good Faith Estimate explaining how much your medical care will cost. Under the law, health care providers must give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

If you believe you've been wrongly billed

Contact the U.S. Department of Health and Human Services at 1-800-985-3059.

Visit www.cms.gov/nosurprises for more information about your rights under federal law.

Visit nj.gov/dobi for more information about your rights under New Jersey law.

You may also contact our billing office at (212) 222-4628 or info@ovadiaps.com with any questions about your bill or your rights.

This notice is provided in accordance with Section 2799B-3 of the Public Health Service Act and 45 CFR 149.430. Last updated February 2026.