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 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 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.
These federal laws apply in all states including Colorado and California. The California Health and Safety Code 1799.102 states: “No person who in good faith, and not for compensation, renders emergency medical or nonmedical care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission” (Jul 21, 2017).
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 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-of-network. You can choose a provider or facility in your plan’s network.
Existing California law prohibits surprise bills (or “balance billing”) for emergency room care and sets standards for reimbursement to doctors and hospitals for most state-regulated health insurance plans.
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 think you’ve been wrongly billed, contact the HHS No Surprises Helpdesk at 1-800-985-3059, which is the entity responsible for enforcing the federal balance or surprise billing protection laws. 1-800-985-3059 (available 8am-8pm ET seven days a week; TTY: 800-985-3059) and webpage (CMS.gov/nosurprises), where more details on registering potential violations can be found. Additional resources about California laws regarding your rights about a surprise bill are also available (call 1-800-927-4357 or go online: https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm).
Filing a Complaint against a psychologist, psychological associate, or registered psychologist
Who May File a Complaint?
Anyone who thinks that a psychologist, psychological associate or registered psychologist has acted illegally, irresponsibly, or unprofessionally may file a complaint with the Board of Psychology. In this document the person who files a complaint is referred to as the “complainant,” and the person against whom the complaint is filed is the “licensee/registrant.”
What Types of Complaints Does the Board Handle?
Complaints under the Psychology Board’s jurisdiction include the following behavior by a psychologist, psychological associate or registered psychologist:
- sexual contact with a patient
- violating the patient’s confidentiality
- providing services for which the individual has not been trained or licensed
- drug abuse
- fraud or other crimes
- false advertising
- paying or accepting payment for patient referral
- unprofessional, unethical, or negligent acts
- focusing therapy on the licensee’s/registrant’s own problems, rather than the patient’s
- serving in multiple roles, i.e., having social relationships with patients, lending them money, employing them, etc.
California Board of Psychology website: https://www.psychology.ca.gov/consumers/filecomplaint.shtml
Board Of Psychology
1625 North Market Blvd., Suite N-215
Sacramento CA 95834
Colorado Board of Psychology website: https://dpo.colorado.gov/Psychology
Division of Professions and Occupations
1560 Broadway, Suite 1350
Denver, CO 80202
Dr. Mikolic is a licensed psychologist in the state of California (PSY32104) and in the state of Colorado (PSY5187).