Patient Rights · No Surprises Act
Your Rights and Protections Against Surprise Medical Bills
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.
The basics
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, like a copayment, coinsurance, or deductible. You may have additional 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" means providers and facilities that haven't signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 plan's deductible or 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.
Federal protections
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 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 balance 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 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.
You're never required 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.
State protections
State protections where SEVA Healthcare provides care
State surprise billing laws add to the federal protections above; they do not replace them. Which law applies to a particular bill depends on the state, your type of health coverage, and the service you received.
Texas
Texas law adds protections for state-regulated plans
Texas law also protects people covered by certain state-regulated health plans from surprise medical bills. Under Texas Senate Bill 1264 and related sections of the Texas Insurance Code, an out-of-network facility-based provider may not bill you more than your plan's copayment, coinsurance, and deductible for a covered service performed at a health care facility that is in your plan's network.
The Texas Department of Insurance explains that Texas protections cover emergency care, air ambulance services, in-network hospital care, labs and imaging ordered by an in-network doctor, and — for services on or after January 1, 2024 — ground ambulance services.
Texas protections apply to state-regulated plans. You can usually tell by looking for "TDI" or "DOI" on your health insurance card. Texas law also applies to certain Employees Retirement System of Texas and Teacher Retirement System of Texas plans, and to some employer plans that chose to follow Texas balance billing law. For non-emergency care, Texas law allows you to be asked to agree in writing, in advance, to see an out-of-network provider — you are not required to agree.
Texas Department of Insurance Help Line: 1-800-252-3439 · Texas Department of Insurance website
Oklahoma
Oklahoma relies on the federal protections
The Oklahoma Insurance Department states that Oklahoma has not enacted state-level protections against surprise billing, and that enforcement of the No Surprises Act for Oklahoma consumers is carried out by the Centers for Medicare & Medicaid Services. The federal protections described on this page apply.
Oklahoma Insurance Department Consumer Assistance: 1-800-522-0071 · Oklahoma Insurance Department website
New Mexico
New Mexico has its own Surprise Billing Protection Act
New Mexico's Surprise Billing Protection Act (NMSA 1978, Section 59A-57A-1 and following, and 13.10.33 NMAC) limits what you owe for a surprise bill to the deductible, coinsurance, or copayment you would normally owe for the same services received in network. It applies to emergency care from an out-of-network provider, and to non-emergency care from an out-of-network provider at an in-network facility when an in-network provider was not available, the services were unforeseen, or you did not specifically consent to that out-of-network provider.
The New Mexico Office of Superintendent of Insurance also explains that a health care provider cannot send a surprise bill to a collection agency, and that if you paid more than you owe for a surprise bill you may be entitled to a refund from the provider.
New Mexico Office of Superintendent of Insurance: 1-855-427-5674 · New Mexico Office of Superintendent of Insurance website
Also true
When balance billing isn't allowed, you also have these protections:
- You're only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
- Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as "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 in-network deductible and out-of-pocket limit.
Who this covers
Who these protections apply to
Most private health coverage
These federal protections apply to people covered by a group health plan or by group or individual health insurance — including coverage through an employer, the Health Insurance Marketplace, a plan bought directly from an insurance company, and the Federal Employees Health Benefits Program.
Medicare, Medicaid and similar programs
If you use Medicare, Medicaid, Indian Health Services, Veterans Affairs health care, or TRICARE, the Centers for Medicare & Medicaid Services explains that these programs already protect you from some unexpected out-of-network bills.
No insurance, or paying yourself
If you don't have health insurance, or you choose not to use your health insurance, different federal protections apply. You have the right to receive a written Good Faith Estimate of your expected charges before you receive care.
Uninsured and self-pay patients: see Good Faith Estimate — know what your care will cost for the protections that apply to you.
Getting help
If you think you've been wrongly billed
- 1
Start with us
Contact SEVA Healthcare and ask us to review the bill. Use the phone number for the state where you received care, or email us.
- 2
Contact the federal No Surprises Help Desk
Call 1-800-985-3059. Help is available in English, Spanish, and more than 350 other languages. You can also submit a complaint to the No Surprises Help Desk.
- 3
Contact your state insurance agency
Use the agency for the state where you received care. Contact details are listed in State protections where SEVA Healthcare provides care.
For more information about your rights under federal law, visit the CMS medical bill rights website.
Contact us
Questions about a SEVA Healthcare bill
Reach our billing team using the number for the state where you received care.
- Phone — Texas
- (214) 306-4116
Lewisville & Rowlett - Phone — Oklahoma
- (918) 935-3240
Tulsa Midtown & Tulsa South - Phone — New Mexico
- (505) 431-2501
Santa Fe - info@sevamedcare.com
Answers
Frequently asked questions
Do these protections apply if I have Medicare or Medicaid?
The federal No Surprises Act protections described on this page apply to group health plans and to group or individual health insurance. If you use Medicare, Medicaid, Indian Health Services, Veterans Affairs health care, or TRICARE, the Centers for Medicare & Medicaid Services explains that these programs already protect you from some unexpected out-of-network bills.
What if I don't have health insurance?
Different federal protections apply. If you are uninsured, or you have insurance but choose not to use it for a scheduled service, you have the right to a written Good Faith Estimate of your expected charges before you receive care. See our Good Faith Estimate page.
Can I be asked to give up these protections?
For emergency services, and for the ancillary services listed above at an in-network hospital or ambulatory surgical center, out-of-network providers may not ask you to give up your protections. For some other non-emergency services at those facilities, you may be asked to give written consent. You are never required to give up your protections from balance billing, and you are not required to get out-of-network care.
Should I contact my state agency or the federal help desk?
Either. Contact the insurance agency for the state where you received care, or the federal No Surprises Help Desk at 1-800-985-3059. The Help Desk can review your complaint and refer it to another federal or state enforcement authority if that is the right place for it.
Does this notice tell me whether SEVA Healthcare is in my network?
No. Network participation depends on your specific health plan. Contact your health plan, or call our billing team using the number for your state, and we will help you check your benefits before your appointment.
About this page
This notice is published to meet the disclosure requirement for health care providers and facilities under section 2799B-3 of the Public Health Service Act and 45 CFR 149.430. The federal sections follow the model disclosure notice published by the Centers for Medicare & Medicaid Services. Federal and state regulations may change over time, and the information here is not legal advice. For questions about your specific situation or your bill, please contact our billing team using the details above.
Last reviewed: · Accessibility concerns: info@sevamedcare.com
