Guide 1: I Have Health Insurance and Need Emergency Care

What if I need emergency transportation?

What if I need emergency transportation?

In an emergency, you may find yourself transported to a hospital in either: 

• An “air ambulance” – a helicopter or airplane equipped with medical equipment and staffed with trained paramedics; or
• A “ground ambulance” which travels by road.

When you call 911, an emergency dispatcher will send the closest available ambulance, which may or may not be part of your insurance network. Because you don’t get to choose the ambulance company — and because requesting an ambulance often means you’re preoccupied with your actual emergency — you may be surprised to later receive an out-of-network ambulance bill.

The No Surprises Act is a national law that protects you from out-of-network “surprise medical bills” from air ambulances, but not from ground ambulances.  

Out-of-network air ambulance transportation

The No Surprises Act protects you from out-of-network “surprise medical bills” for emergency air ambulance transportation. You will only be responsible for paying the total amount that would have been charged if that air ambulance was in your health insurance plan’s network.

Remember: The air ambulance company cannot send you an out-of-network “surprise medical bill.”

Out-of-network ground ambulance transportation

The No Surprises Act does not protect you from out-of-network “surprise medical bills” from ground ambulances. However, 22 states offer some limited protections.

Know the limits of your state’s protections

Even if you live in one of these 22 states, the protections are only available for people who are insured by their state-regulated health insurance plans. Call the number on your health plan’s insurance card to find out if your plan is regulated under your state’s laws.

What’s more, each of these states offer different types of protections from ground ambulance “surprise medical bills.” To learn more about your state’s protections, contact your state insurance department. If you do not live in one of these 22 states, you could receive a bill directly from a ground ambulance service if that ambulance is not in your health plan’s provider network. 

If you receive an out-of-network bill for a ground ambulance service and you can’t afford it, you can work with your health insurance plan and the ambulance company to negotiate the cost of these additional charges.

Note: most insurance plans don’t cover non-emergency transportation, so look for less expensive alternative medical transportation services if you think you might need it. 

• When you are offered emergency transport, you usually have the right to decline. For example, you might decline if you can be safely driven to the hospital by a family member or neighbor. Your health should come first, however. Do not put yourself at risk in order to avoid bills. 

What if I need emergency room care?

What if I need emergency room care?

Emergency care is expensive, but your health is the priority.

• If you are experiencing a medical emergency, visit the nearest emergency room as quickly as possible — regardless of whether it is in your health insurance plan’s in-network hospital system. 
• Almost all hospitals are required to treat patients who come to the emergency room (ER) with a medical emergency. This applies even if the patient cannot pay. 
  • Hospitals must screen each patient who comes to the ER to see whether the patient has an emergency medical condition. 
  •  If the patient has an emergency medical condition, the hospital must offer treatment to stabilize the condition. “Stabilize” means that the condition is not likely to get materially worse from the patient’s discharge or transfer from the hospital. 
  • If a pregnant woman is having contractions and cannot be safely transferred to another facility, this is considered an emergency medical condition. In this case, the patient is “stabilized” when the baby and the placenta have been delivered. 
  • Once the person is stabilized, the hospital can discharge (release) the patient, even if they need additional non-emergency care. 
  • If you believe a hospital did not follow these requirements, you can file a complaint. 

Urgent care centers

Urgent care centers, which are prevalent across the U.S., are not included in No Surprises Act’s list of eligible emergency care facilities unless they are licensed to provide emergency services and separate from a hospital. That means if you visit an urgent care center that does not meet these requirements, you are not protected against “surprise medical bills.” 

It is sometimes difficult to know whether an urgent care center is licensed in a way that protects you from “surprise medical bills.” If you think you don’t need full emergency services, urgent care centers are significantly less expensive than hospital emergency rooms and therefore might be a better choice. To avoid “surprise medical bills,” be sure to check which urgent care centers near you are in-network and try to use those locations when possible.

Protections from out-of-network emergency room services

The No Surprises Act protects you from “surprise medical bills” when you receive treatment for an emergency in an out-of-network emergency room and/or from out-of-network emergency room doctors. These protections apply to emergency rooms that are either: part of a hospital; independent, free-standing emergency departments; or behavioral health crisis facilities that are licensed to provide emergency care. 

• Through the No Surprises Act’s protections, you will only owe the out-of-pocket costs that would have been charged if that emergency room and its physicians were in your health insurance plan’s network. These costs also count toward your annual deductible.
• The emergency room and its physicians cannot send you a balance bill. Furthermore, no one can ask you to sign a consent form to waive your out-of-network “surprise medical bill” protections in an emergency room.
• Health insurance plans cannot deny coverage for emergency care if you are deemed reasonable in thinking that you need immediate attention from health professionals.

How long does the No Surprises Act protect me against “surprise medical bills”?

If you are treated for an emergency at an out-of-network hospital, you are protected from “surprise medical bills” under the No Surprises Act.

However, after the medical emergency is over, in a period called “post stabilization care” those billing protections could end. This can even occur while you are still in the hospital. 

If you are able to travel without medical help to a nearby in-network provider and you are healthy enough to be aware and give “informed consent,” you could be asked to sign a “consent form” for out-of-network post-stabilization services. If you sign that form, you will not be protected from out-of-network bills. 

In this circumstance, if you do not sign the consent form, you will likely be asked to leave the hospital and seek further services at an in-network health care facility. 

Consenting to out-of-network care

You cannot be asked to leave the out-of-network hospital or to consent to the additional out-of-network charges UNLESS your doctors determine that:

• You do not need emergency medical transportation to get to an in-network health care facility.
• The in-network facility is within a reasonable travel distance, considering your medical condition.
• The in-network facility has an available bed for you to use after they admit you.
• You are well enough to understand the reasons why you must transfer to a new hospital and are able to give consent in writing.

You will be given a consent form that looks like this. Do you have questions about consent forms or this process? Use this explainer or these tips.

What do I do if I receive an illegal “surprise medical bill”?

What do I do if I receive an illegal “surprise medical bill”? 

If you receive an out-of-network “surprise medical bill” from an air ambulance company, emergency room, or emergency doctors, follow these steps:

Step 1

Contact both your health insurance plan and the health care provider (such as the out-of-network hospital or the air ambulance company) immediately to say: “I believe I have received an out-of-network bill that is illegal under the No Surprises Act. I do not owe more than my in-network amount on this bill.” Then ask the health care provider or the insurer to send you a written or emailed confirmation that you do not owe the amount of the out-of-network “surprise medical bill.”

Step 2

File a complaint online or call 1-800-985-3059. Even if you have gotten the company to stop its collection efforts on an illegal bill, it is important to notify the government of companies that are violating the law. After you file a complaint, you will receive information about when to expect a response.