Protections Against Surprise Medical Bills

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, and/or a 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 is not in your health plan’s network.

“Out-of-network” means providers and facilities that have not 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

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 the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles), subject to applicable state law. You can’t 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.

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 may bill you is your plan’s in-network cost-sharing amount, subject to applicable state law. 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 are never required to give up your protections from balance billing. You also are not required to get out-of-network care. You can choose a provider or facility in your plan’s network.

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 or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Generally, your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (also known as "prior authorization").
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

When is balance billing allowed?

Not all services are protected from balance billing – generally only the above is protected. Subject to state law, you may be balance billed for certain services from ground ambulance providers, services not covered by your medical plan, and non-emergency services received by an out-of-network provider or at an out-of-network facility.

If you think you have been wrongly billed, contact your applicable state agency or the U.S. Department of Health & Human Services (HHS) at 200 Independence Avenue SW, Washington, DC 20201, Toll Free: 1-800-985-3059.

Visit https://www.cms.gov/nosurprises for more information about your rights under federal law.

DISCLAIMER: All benefits will be administered in accordance with the terms of the applicable General Dynamics Corporation legal plan documents. In the event of any conflict between the applicable legal plan documents and the information described above, the applicable legal plan documents (as interpreted by the plan administrator) will control. As always, General Dynamics Corporation reserves the right and discretion to interpret the terms of its plans and to amend or terminate its benefit plans at any time in accordance with applicable law.