Federal No Surprises Act Protections

Federal law generally limits surprise or balance billing for emergency services and for certain non-emergency services provided by out-of-network professionals at participating hospitals, hospital outpatient departments, and ambulatory surgical centers. In protected situations, patients generally may be charged only the applicable in-network cost-sharing amount.

Notice and Consent

In certain non-emergency situations, federal law may allow an out-of-network provider to ask a patient to consent to receive out-of-network care and waive certain balance-billing protections. Federal law does not allow waiver of protections for certain ancillary services and other circumstances. LCI will use any notice-and-consent process only when legally permitted.

Illinois Protections

Illinois law also limits balance billing in specified circumstances, including certain emergency services and certain non-emergency services furnished by nonparticipating providers at participating health care facilities. When Illinois law provides greater protection than federal law, the applicable Illinois protection will be followed.

What You May Owe

When surprise-billing protections apply, your responsibility is generally limited to the cost-sharing amount that would apply under the governing law and your health plan. When those protections do not apply, an out-of-network provider or facility may be permitted to charge more than the in-network cost-sharing amount, depending on your coverage and applicable law.

Never Give Up Your Protections Unless You Understand the Choice

You are not required to waive federal surprise-billing protections where the law prohibits waiver. Where notice and consent is legally permitted, carefully review the notice, available in-network alternatives, and estimated costs before deciding.

If You Believe You Were Improperly Billed

You may contact the federal No Surprises Help Desk at 1-800-985-3059 or visit the Centers for Medicare & Medicaid Services website for information about federal protections and complaints. For questions regarding Illinois insurance protections, you may also contact the Illinois Department of Insurance.