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Your Rights and Protections Against Surprise Medical Bills

When you receive 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, or 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 is not in your health plan’s network.

“Out-of-network” describes providers and facilities that have not 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 often 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 cannot control who is involved in your care, such as during 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 cannot be balance billed for these emergency services. This includes services you may receive after you are stable, unless you give written consent and agree to be billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center
When you receive 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 services such as:

These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.

If you receive other services at these in-network facilities, out-of-network providers cannot balance bill you unless you give written consent and agree to give up your protections.

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

Additional protections

When balance billing is not allowed, you also have the following protections:

More information about your rights and protections

For more information about your rights under federal law, visit:
https://www.cms.gov/nosurprises.

For information about your rights under Massachusetts law, visit: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111/Section228.

Questions or concerns

If you have questions about a bill you receive from Lutanen Health, please contact our billing department at:

Phone: 617-676-2592
Email: ea@lutanen.com

If you believe you have been wrongly billed, you may contact:

Effective: January 1, 2022

Do we need the below?

Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the expected charges for medical services.

For questions or more information about your right to a Good Faith Estimate, visit
www.cms.gov/nosurprises or call 1-800-985-3059.

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