© 2022 Fannie Mae 10.5.22 Page 1 of 2

Your Rights and Protections Against Surprise Medical Bills

For plan years beginning on or after January 1, 2022

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory

surgical center, you are protected by federal law from surprise billing or balance 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. You may have other 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” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network 

providers may be permitted to bill you for the difference between what your plan agreed to pay 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 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.

You are 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 the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as deductibles, 

copayments and coinsurance). 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-ofnetwork. In these cases, the most those providers may 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 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 care out-ofnetwork. You can choose a provider or facility in your plan’s network.
© 2022 Fannie Mae 10.5.22 Page 2 of 2

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that 

you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and 

facilities directly.

• Your health plan generally must:

o Cover emergency services without requiring you to get approval for services in advance (prior 

authorization).

o Cover emergency services by out-of-network providers.

o 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.

o Count any amount you pay for emergency services or out-of-network services toward your deductible and 

out-of-pocket limit.

If you believe you’ve been wrongly billed, you may call the Department of Health and Human Services or the Customer 

Service number on your insurance ID card for more information.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under 

federal law. 

*For enrollees in Kaiser Mid-Atlantic or Kaiser California coverage, please refer to Kaiser’s notice which will be posted on 

www.kp.org. You may contact Kaiser Mid-Atlantic at 1-800-777-7904 and Kaiser California at 1-800-464-4000 for 

additional information.