Your Rights and Protections Against Surprise Medical Bills


When you get emergency care or get treated by an non-Preferred Provider at a Preferred hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?


The IBEW Local 22/NECA Health and Welfare Plan (“Fund”) offers the UnitedHealthcare network of physicians, hospitals, facilities, and other health care providers. UnitedHealthcare contracts with these providers to offer medical treatment to you and your dependents at reduced rates. This network of providers is called a Preferred Provider Organization (“PPO”), and the providers in the network are called “Preferred Providers.”


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 non-Preferred provider.


Non-Preferred providers may be permitted to bill you for the difference between the Reasonable Allowance (as that term is denied in the Fund’s Summary Plan Description) and the full amount charged for a service. This is called “balance billing.” This amount is likely more than what would be charged by a Preferred Provider, and it does not count toward your deductible or annual medical out-of-pocket limit.


“Surprise billing” is an unexpected balance bill. This can happen when you cannot control who is involved in your care—like when you have an emergency or when you schedule a visit at a Preferred facility but are unexpectedly treated by a non-Preferred provider.


You are protected from balance billing for:


Emergency services


If you have an emergency medical condition and get emergency services from a non-Preferred provider, the most the provider may bill you is the Fund’s cost-sharing amount for Preferred Providers. You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.


Likewise under Nebraska state law, if you have an emergency medical condition and get emergency services from a non-Preferred Provider, the most the provider may bill you is the Fund’s cost-sharing amount for Preferred Providers.


Certain services at a Preferred hospital or ambulatory surgical center


When you get services from a Preferred hospital or ambulatory surgical center, certain providers there may be non-Preferred providers. In these cases, the most those providers may bill you is the Fund’s cost-sharing amount that applies to Preferred Providers. This applies to
emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, and assistant surgeon, hospitalist, and 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 a Preferred facility, non-Preferred providers cannot balance bill you, unless you give written consent and give up your protections.


You are never required to give up your protections from balance billing. You also are not required to get care from non-Preferred providers. You can choose a Preferred Provider or facility.


When balance billing is not allowed, you also have the following protections:

You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles) that you would pay if the provider had been a Preferred Provider. The Fund will pay remaining amounts to the non-Preferred providers.

The Fund generally must:


Cover emergency services without requiring you to get approval for services in advance   (prior authorization).

Cover emergency services rendered by non-Preferred providers.

Base what you owe the provider (cost-sharing) on what it would pay a Preferred Provider or facility and show that amount in your explanation of benefits.

Count any amount you pay for emergency services or non-Preferred services toward your deductible and annual medical out-of-pocket limit.


If you believe you have been wrongly billed, you may contact the Fund Office 1-866-315-1739 or by mail at IBEW Local 22/NECA Health & Welfare Plan, Electrical Industry Center, 8960 L Street, Suite 101, Omaha, NE 68127-1414.

The Fund Office is available to answer questions and will work to confirm your No Surprises Act claims are processed with appropriate balance billing protections applied.

If a provider is balance billing you in error, you may file a complaint with the federal government at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.


Visit https://www.cms.gov/nosurprises for more information about your rights under federal law. For your rights under state law, please visit your state’s insurance department or related agency’s website.

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