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When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.��

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 co-payment, co-insurance 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" describes 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 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. 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 can bill you is your plan’s in- network cost-sharing amount (such as copayments, coinsurance or deductibles). 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.��

Non-Emergency Services��

• The hospital or facility must tell you if you are at an out-of-network location or at an in-network location that is using out-of-network providers. It must also tell you what types of services may be provided by any out-of-network provider.
• You have the right to request that in-network providers perform all covered medical services. However, you may have to receive medical services from an out-of-network provider if an in-network provider is not available. When this happens, the most you can be billed for covered services is your in-network cost-sharing amount (copayments, deductibles and/or coinsurance). These providers cannot balance bill you.��

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.��

Under Colorado law, if you receive services from an out-of-network provider, hospital or facility in any other situation, you may still be balance billed, or you may be responsible for the entire bill. If you intentionally receive non-emergency services from an out-of-network provider or facility, you may also be balance billed.��

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 co-payments, co-insurance, 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 must:
  • Cover emergency services without requiring you to get approval for services in advance (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 deductible and out-of-pocket limit.��

If you believe you’ve been wrongly billed:

• Please contact the HW billing department by emailing WardenburgBilling@colorado.edu.
• You may also contact the Colorado Department of Regulatory Agencies Consumer Services Division by calling 1-800-930-3745 or emailing DORA_Insurance@state.co.us.
• Please visit for more information about your rights under Federal law.
• Visit for more information about your rights under Colorado law.