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Info

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.

Through the No Surprises Act, you are protected from surprise or balance billing * in three main scenarios:

  1. A person gets covered emergency services from an out-of-network provider or out-of-network emergency facility.
  2. A person gets covered non-emergency services from an out-of-network provider delivered as part of a visit to an in-network health care facility.
  3. A person gets covered air ambulance services provided by an out-of-network provider of air ambulance services.

You can only be balanced billed for one of these scenarios if you give the provider permission to do so by signing a surprise bill protection form. You aren’t required to provide permission and shouldn’t sign the form if you
didn’t choose a health care provider before scheduling care. You can choose to get care from a provider or facility in-network, which may cost you less. To find an in-network provider, please call the number on the
back of your GuideStone® ID card.

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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.

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“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.

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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 may 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 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 protection 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 isn’t allowed, you also have the following protections:

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