{"id":18385,"date":"2022-07-01T07:23:41","date_gmt":"2022-07-01T11:23:41","guid":{"rendered":"https:\/\/www.bu.edu\/hr\/?page_id=18385"},"modified":"2022-07-01T09:05:32","modified_gmt":"2022-07-01T13:05:32","slug":"the-transparency-in-coverage-rule-and-the-consolidated-appropriations-act","status":"publish","type":"page","link":"https:\/\/www.bu.edu\/hr\/health-wellness\/health\/the-transparency-in-coverage-rule-and-the-consolidated-appropriations-act\/","title":{"rendered":"The Transparency in Coverage Rule and The Consolidated Appropriations Act"},"content":{"rendered":"

The Transparency in Coverage Rule and Machine-Readable Files<\/h2>\n

Under the Transparency in Coverage Rule, health plans are required to disclose in-network provider negotiated rates and historical out-of-network allowed amounts through machine-readable files (MRFs).\u00a0 In order to view these files, please visit the Blue Cross Blue Shield website<\/a>.<\/p>\n

The Consolidated Appropriations Act and Your Rights and Protections Against Surprise Medical Bills<\/h2>\n

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.<\/p>\n

What is \u201cbalance billing\u201d (sometimes called \u201csurprise billing\u201d)?<\/strong>
\nWhen 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\u2019t in your health
\nplan\u2019s network.<\/p>\n

\u201cOut-of-network\u201d describes providers and facilities that haven\u2019t 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 \u201cbalance billing.\u201d This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.<\/p>\n

\u201cSurprise billing\u201d is an unexpected balance bill. This can happen when you can\u2019t control who is involved in your care\u2014like 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.<\/p>\n

You are protected from balance billing for:<\/strong>
\nEmergency services<\/strong>
\nIf 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\u2019s in- network cost-sharing amount (such as copayments and coinsurance). You can\u2019t be balance
\nbilled for these emergency services. This includes services you may get after you\u2019re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.<\/p>\n

Certain services at an in-network hospital or ambulatory surgical center<\/strong>
\nWhen 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\u2019s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can\u2019t balance bill you and may not ask you to give up your protections
\nnot to be balance billed. If you get other services at these in-network facilities, out-of-network providers can\u2019t balance bill you, unless you give written consent and give up your protections.<\/p>\n

You\u2019re never<\/span> required to give up your protections from balance billing. You also aren\u2019t required to get care out-of-network. You can choose a provider or facility in your plan\u2019s network.<\/strong><\/p>\n