When you get emergency care or are treated by an out-of-network provider at an in-
network hospital or ambulatory surgical center, you are protected from balance
billing. In these cases, you shouldn't be charged more than your plan's copayments,
coinsurance and/or deductible.
+ What is "balance billing" (sometimes called "surprise billing")?
- At The Woodlands Sports Medicine Centre you're 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 we will bill you is your plan's in-network cost-sharing amount (such as
copayments, coinsurance, and deductibles). You will not 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.
CERTAIN SERVICES AT AN IN-NETWORK HOSPITAL OR AMBULATORY SURGICAL CENTER
When you get services from an in-network hospital or ambulatory surgical center, it is possible some
providers may be out-of-network. In these cases, the most these out-of-network providers will 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 types of 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.
We'll never require you to give up your protections from balance billing. You also aren't required to get
out-of-network care. You can choose a provider or facility in your plan's network.
+ When balance billing isn't allowed, you also have these protections:
