Surprise Billing | Paying for Your Care | Legacy Health Manage your account, request prescriptions, set up appointments & more. Don't have an account CREATE AN ACCOUNT > MyHealth MyHealth Manage your account, request prescriptions, set up appointments & more. Don't have an account CREATE AN ACCOUNT > Doctors & Locations Services & Resources Services Resources Patients & Visitors About Your Care Paying for Your Care Visit or Volunteer Giving & Support Ways to Give Get Involved Community Benefit About Who We Are News & Media For Health Professionals Refer a Patient Tools & Resources Legacy Research Institute Education for Health Professionals Careers Your Rights and Protections Against Surprise Medical Bills and Balance Billing Patients & Visitors Paying for Your Care No Surprise Billing Paying for Your Care Price Transparency MyHealth Message Fees FAQ Financial Assistance Paying for Your Care 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 surprise billing or balance billing. Balance Billing Protection Notice Balance Billing Protection Consent Right to Receive a Good Faith Estimate Patient Request Form Co-provider Request Form Request a patient or co-provider estimate 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service. Insurers are required to tell you, via their websites or on request, which providers, hospitals and facilities are in their networks. Hospitals, surgical facilities and providers must tell you which provider networks they participate in on their website or on request. You are protected from balance billing for: Emergency Services If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance and deductibles). 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. 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 can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeons, hospitalists, or intensivist services. These providers cannot balance bill you and cannot 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. When balance billing is allowed Balance billing is allowed when seeking non-emergent care at a healthcare facility that is not in your insurance network. 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: – Cover emergency services without requiring you to get approval for services in advance (prior authorization). – Cover emergency services by out-of-network providers. – 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. – Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit. If you believe you’ve been wrongly billed, you may file a complaint with: Legacy Health Website: www.legacyhealth.org/billingcontactus Phone: 503-413-4048 Federal Government Website: www.cms.gov/nosurprises/consumers Phone 1-800-985-3059 Oregon Division of Financial Regulations Website: dfr.oregon.gov/insure/Pages/index.aspx Email DFR.InsuranceHelp@dcbs.oregon.gov Phone 1-888-877-4894 Washington State Office of the Insurance Commissioner Website: www.insurance.wa.gov Phone 1-800-562-6900 Visit www.cms.gov/nosurprises for more information about your rights under federal law. Visit the Office of the Insurance Commissioner Balance Billing Protection Act website for more information about your rights under Washington state law. Heath plans that work with Legacy Health Medical Centers in Oregon We have published a list of insurance plans we work with at Legacy Health Medical Centers in Oregon; see the list . Please check with your insurance company to see what is covered. Legacy Salmon Creek Medical Center Patients: Washington state law also protects you from 'surprise billing' or 'balance billing' if you receive emergency care or are treated at an in-network hospital or outpatient surgical facility. This applies to insurance plans that have opted in or have been opted in by default to this Washington state law, and is a Washington state administered insurance.