![]() ![]() They also must limit your copays, coinsurance, or deductibles to in- network amounts if you rely on inaccurate information in a provider directory. Other protections in the new law require insurance companies to keep their provider directories updated.A similar dispute resolution process is available for individuals who are uninsured, in certain circumstances, such as when the actual charges are much higher than the estimated charges. Providers and insurance companies can use this process to settle disputes about your bill without putting you in the middle. An independent dispute resolution (IDR) process, or another process your state sets up, is available to settle bills.You also can file a complaint with the Wisconsin Office of the Commissioner of Insurance ( oci.wi.gov/Complaints) or the federal Department of Health and Human Services ( cms.gov/nosurprises/consumers/ If you've received a surprise bill that you think isn't allowed under the new law, you can file an appeal with your insurance company or ask for an external review of the company's decision.Your health plan and the facilities and providers that serve you must send you a notice of your rights under the new law.If you did that, you'd be expected to pay the balance bill as well as your out-of-network coinsurance, deductibles, and copays. The provider must give you information in advance about what your share of the costs will be. You still can agree in advance to be treated by an out-of-network provider in some situations, such as when you choose an out-of-network surgeon knowing the cost will be higher.You can never be asked to waive your protections and agree to pay more for out- of-network care at an in-network facility for care related to emergency medicine, anesthesiology, pathology, radiology, or neonatology-or for services provided by assistant surgeons, hospitalists (doctors who focus on care of hospitalized patients), and intensivists (doctors who care for patients needing intensive care), or for diagnostic services including radiology and lab services.An out-of- network provider may not bill you more than your in-network copays, coinsurance, or deductibles for covered services performed at an in-network facility. The new law also protects you when you receive non-emergency services from out-of- network providers (such as an anesthesiologist) at in-network facilities.If your health plan requires you to pay copays, coinsurance, and/or deductibles for in- network care, you're responsible for those. ![]()
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