Surprise billing definition

Surprise billing means any bill received by an enrollee or insured for
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Surprise billing is an unexpected balance bill. This can happen when you can’t control who is involvedin 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. Providers and facilities are not balance billing you when they seek to collect cost sharing or another amount that you agreed to pay or are required to pay under your plan for the services that they provided.
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Surprise billing means balance billing from an out-of-network provider in a situation where you could not 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.
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Examples of Surprise billing in a sentence

  • Surprise billing occurs when an individual receives an unexpected bill after obtaining items or services from an out-of-network (OON)2 provider, facility, or provider of air ambulance services where the individual did not have the opportunity to select a facility, provider, or provider of air ambulance services covered by their health insurance network (in- network), such as during a medical emergency.

  • This is what is known as “balance billing.” Surprise billing frequently occurs where an individual chooses an in-network provider or facility and unknowingly has an out-of-network provider involved in their care; thus, the patient is stuck with additional (above contract) costs related to the out-of-network provider’s involvement in their care.

  • Surprise billing protections should be applicable regardless of provider type or care setting.

  • Surprise billing occurs when an individual receives an unexpected bill after obtaining items or services from an out-of-network (OON)2 provider, facility, or provider of air ambulance services where the individual did not have the opportunity to select a provider, facility, or provider of air ambulance services covered by their health insurance network (in- network), such as during a medical emergency.

  • Surprise billing occurs when an individual receives an unexpected bill after obtaining items or services from an out-of-network (OON)2 provider, facility, or provider of air ambulance services where the individual did not have the opportunity to select a provider, facility, or provider of air ambulance services covered by their health insurance issuer’s or plan’s network (in-network), such as during a medical emergency.

  • Surprise billing occurs when an individual receives an unexpected medical bill after obtaining items or services from an out-of-network (OON) provider, facility, or provider of air ambulance services where the individual did not have the opportunity to select a provider, facility, or provider of air ambulance services covered by their health insurance network (in- network), such as during a medical emergency.

  • Surprise billing can occur for a variety of reasons, including the inadequacy of a plan’s provider network.

  • Surprise billing occurs both for emergency and non- emergency care.

  • Surprise billing occurs when an individual receives an unexpected medical bill after obtaining items or services from an out-of-network (OON)2 provider, facility, or provider of air ambulance services where the individual did not have the opportunity to select a provider, facility, or provider of air ambulance services covered by their health insurance issuer’s or plan’s network (in-network), such as during a medical emergency.

  • Surprise billing, sometimes known as balance billing, is the practice in which a healthcare provider charges more money above what your insurance will cover, usually as a result of receiving care from an out-of-network provider while at an in-network facility.


More Definitions of Surprise billing

Surprise billing means the practice by a health care
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Related to Surprise billing

  • Balance billing means charging or collecting an amount in excess of the Medicaid, Medicare, or contracted reimbursement rate for services covered under a Medicaid, Medicare or employer sponsored beneficiary’s plan. “Balance Billing” does not include charging or collecting deductibles or copayments and coinsurance required by the beneficiary’s plan.

  • Net energy billing means a billing and metering practice under which a customer-generator is billed on the basis of net energy over the billing period.

  • Rechargeable Electrical Energy Storage System (REESS) means the rechargeable energy storage system that provides electric energy for electrical propulsion.

  • Opaque means impenetrable to sight.

  • Energy Use Intensity (EUI means the kBTUs (1,000 British Thermal Units) used per square foot of gross floor area.

  • Sailboat means the same as that term is defined in Section 73-18-2.

  • Meet-Point Billing (MPB) refers to the billing associated with interconnection of facilities between two or more LECs for the routing of traffic to and from an IXC with which one of the LECs does not have a direct connection. In a multi-bill environment, each Party bills the appropriate tariffed rate for its portion of a jointly provided Switched Exchange Access Service.

  • Enterprise zone means a neighborhood enterprise zone designated under the neighborhood enterprise zone act, 1992 PA 147, MCL 207.771 to 207.787.

  • MDF means a CenturyLink distribution frame (e.g., COSMIC™ frame) used to connect CenturyLink cable pairs and line and trunk equipment terminals on a CenturyLink switching system. "Maintenance and Repair" involves the exchange of information between Carriers where one initiates a request for maintenance or repair of existing products and services or Unbundled Network Elements or combinations thereof from the other with attendant acknowledgments and status reports in order to ensure proper operation and functionality of facilities. "Maintenance of Service charge" is a Miscellaneous Charge that relates to trouble isolation work performed by CenturyLink. Basic Maintenance of Service charges apply when the CenturyLink technician performs work during standard business hours. Overtime Maintenance of Service charges apply when the CenturyLink technician performs work on a business day, but outside standard business hours, or on a Saturday. Premium Maintenance of Service charges apply when the CenturyLink technician performs work on either a Sunday or CenturyLink recognized holiday.

  • Functional behavioral assessment means an individualized assessment of the student that results in a team hypothesis about the function of a student’s behavior and, as appropriate, recommendations for a behavior intervention plan.

  • NOC means National Olympic Committee.

  • HRS means Hawaii Revised Statutes.

  • Distance education means education imparted by combination of any two or more means of communication, viz. broadcasting, telecasting, correspondence courses, seminars, contact programmes and any other such methodology;

  • Pilot or "Payment in Lieu of Tax" shall mean any payment made to the Agency or an affected tax jurisdiction equal to all or a portion of the real property taxes or other taxes which would have been levied by or on behalf of an affected tax jurisdiction with respect to a project but for tax exemption obtained by reason of the involvement of the Agency in such project, but such term shall not include Agency fees.

  • Multiple Bill/Single Tariff means the billing method used when Switched Exchange Access Services is jointly provided by the Parties. As described in the MECAB document, each Party will render a bill in accordance with its own tariff for that portion of the service it provides. Each Party will bill its own network access service rates.

  • NBOME means the National Board of Osteopathic Medical Examiners, an organization that prepares and administers qualifying examinations for osteopathic physicians.

  • HUB means Historically Underutilized Business, as defined by Chapter 2161 of the Texas Government Code.

  • Distribution center means a building or structure used primarily for the storage of goods which are intended for subsequent shipment to retail outlets. Distribution center does not mean a building or structure used primarily to store raw agricultural products, used primarily by a manufacturer to store goods to be used in the manufacturing process, used primarily for the storage of petroleum products, or used for the retail sale of goods.

  • Cost center means a cost category delineated by cost reporting forms prescribed by the office.

  • Levee system means a flood protection system which consists of a levee, or levees, and associated structures, such as closure and drainage devices, which are constructed and operated in accordance with sound engineering practices.

  • Audit trail means a documented history of a financial transaction by which the transaction can be traced to its source.

  • MONTHLY KILOMETREAGE STATEMENT CUM BILL means the format specified by the Company.

  • LCC-300 Cost Centre E Terminus Building - Structure Lump Sum Breakdown E5 : Station (GL X7-27/M-Q, 21.96m-28.82m) Lump Sum Item LSE5.3 E5.3 : Walls Contractor's Other Charges The Contractor shall enter hereunder any specific item of work or obligation or thing which is necessary for the execution of the Works, as required by the Contract, which has been omitted from or has not been separately itemised in this Lump Sum Breakdown and for which a separate charge is required. The unit of measurement for any Contractor's Other Charges shall be "sum", with Quantity and Rate columns entered with "N/A". ---------------------------------------------------------------------------------------------------------------- To Collection of Lump Sum Item LSE5.3 *** ----------- *** Certain information on this page has been omitted and filed separately with the Securities and Exchange Commission. Confidential treatment has been requested with respect to the omitted portions. [STAMP]

  • Utilization management section means “you or your authorized representative.” Your representative will also receive all notices and benefit determinations.

  • Project Management Plan means the portion of the Project Development Plan providing the information requested in Section 4.2 of Exhibit B to the ITP.

  • Reception center means a business that: