Billing & Payment Information

Helena Hospital is dedicated to providing exceptional care to every patient. Sometimes, a patient may receive care from a provider who isn’t part of their medical insurance coverage, which could lead to unexpected bills. Helena Hospital follows federal No Surprises Act protections to help shield patients from these situations.

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.

You Are 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 cannot be balance billed for these emergency services, including services you may get after you’re in stable condition, unless you give written consent and give up your protections.

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 cannot balance bill you and may not ask you to give up your protections.

You are 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.

When Balance Billing Isn’t Allowed, You Also Have These Protections:

• You’re only responsible for paying your share of the cost (the copayments, coinsurance, and deductible 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 in advance (prior authorization).
• Your health plan must cover emergency services by out-of-network providers.
• Your health plan must base what you owe on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Your health plan must count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If You Think You’ve Been Wrongly Billed

Contact HHS, in coordination with the Department of the Treasury, Department of Labor, and the Office of Personnel Management. The federal phone number for information and complaints is 1-800-985-3059. For more information about your rights under federal law, visit www.cms.gov/nosurprises/consumers.