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Understanding the cost of your care is important. At University of Maryland Medical System, we are here to help you understand your upcoming health care costs and all assistance programs available to you so you can plan for your care.
Beginning January 1, 2022, the federal No Surprises Act protects patients from surprise medical bills from an out-of-network provider, out-of-network facility, or out-of-network air ambulance provider. The law aims to help both insured and uninsured patients understand and plan for health care costs in advance of care and to minimize unforeseen — or surprise — medical bills.
Individuals with Medicare, Medicare Advantage, Medicaid, Indian Health Services, Veteran Affairs health care, or TRICARE insurance plans are not covered under the No Surprises Act because these federal insurance programs have existing protections in place to minimize large, unforeseen bills.
When you get emergency care by an out-of-network provider or facility or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing.
“Out-of-network” describes providers and facilities that have not 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 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.
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). 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.
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 cannot 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 cannot balance bill you, unless you give written consent and give up your protections.
If you are in a Health Maintenance Organization (HMO) governed by Maryland law, you may not be balance billed for services covered by your plan, including ground ambulance service. If you are in a PPO or EPO governed by Maryland law, hospital-based or on-call physicians paid directly by your PPO or EPO (assignment of benefits) may not balance bill you for services covered under your plan and can’t ask you to waive your balance billing protections.
If you use ground ambulance services operated by a local government provider who accepts an assignment of benefits from a plan governed by Maryland law, the provider may not balance bill you.
Uninsured and self-pay patients have a right to receive a good faith estimate ahead of scheduled nonemergency health care services. A good faith estimate shows the cost of items and services that are reasonably expected for the scheduled service. The estimate is based on information known at the time the estimate was created and can include costs related to your visit such as medical tests, imaging studies, medications, and hospital fees.
While you may request a good faith estimate at any time, the University of Maryland Medical System will provide one in writing to uninsured patients who schedule services at least three days in advance.
The fastest way to receive an estimate is through your MyChart account where you can use our cost estimator tool to estimate the costs associated with your hospital care. If you do not have MyChart, you can get instructions on how to access the tool as a guest.
If you have questions related to receiving a good faith estimate, call 410-821-4140 or 877-632-4909 (toll free) or email CBOService@umm.edu.
If you have questions about your bill from a University of Maryland Medical System member organization, please contact our Customer Service team at (410) 821-4140 or (877) 632-4909 (toll free) or email CBOService@umm.edu.
If you think you have been wrongly billed, you may contact the Health Education and Advocacy Unit (HEAU) of Maryland’s Consumer Protection Division:
If you think your health plan processed your claim incorrectly, you may contact the Maryland Insurance Administration:
Visit https://www.cms.gov/nosurprises for more information about your rights under federal law.
Primary, specialty or urgent care virtual visits