Your Rights: Billing & Fees
If You Have Insurance
Colorado state law protects anyone who has a “CO-DOI” on their health insurance ID card from "surprise billing" or “balance billing”, which is when you're billed for more than the amount your insurance says you'll have to pay for a medical or mental healthcare service. This protection applies in these situations:
Emergency Services
If you are receiving emergency services, the most you can be billed for is your plan’s in-network cost-sharing amounts, which are copayments, deductibles, and/or coinsurance. You cannot be balance-billed for any other amount. This includes both the emergency facility where you receive emergency services and any providers that see you for emergency care.
Non-Emergency Services at an In-Network or Out-of-Network Health Care Provider
Health care providers 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. They must also tell you if any types of services that you will be using might 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. In this case, the most you can be billed for covered services is your in-network cost-sharing amount, which are copayments, deductibles, and/or coinsurance. These providers cannot balance bill you for additional costs.
Additional Protections
If you want to file a complaint against a health care provider, you can submit an online complaint by visiting this website: https://www.colorado.gov/pacific/dora/DPO_File_Complaint. If you think you have received a bill for amounts other than your copayments, deductible, and/or coinsurance, you can contact the billing department, or the Colorado Division of Insurance at 303-894-7490 or 1-800-930-3745. You can contact your health insurance plan at the number on your health insurance ID card or the Colorado Division of Insurance with questions.
Colorado state law protects anyone who has a “CO-DOI” on their health insurance ID card from "surprise billing" or “balance billing”, which is when you're billed for more than the amount your insurance says you'll have to pay for a medical or mental healthcare service. This protection applies in these situations:
- You receive covered emergency services, other than ambulance services, from an out-of-network provider in Colorado,
- You unintentionally receive covered services from an out-of-network provider at an in-network facility in Colorado
Emergency Services
If you are receiving emergency services, the most you can be billed for is your plan’s in-network cost-sharing amounts, which are copayments, deductibles, and/or coinsurance. You cannot be balance-billed for any other amount. This includes both the emergency facility where you receive emergency services and any providers that see you for emergency care.
Non-Emergency Services at an In-Network or Out-of-Network Health Care Provider
Health care providers 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. They must also tell you if any types of services that you will be using might 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. In this case, the most you can be billed for covered services is your in-network cost-sharing amount, which are copayments, deductibles, and/or coinsurance. These providers cannot balance bill you for additional costs.
Additional Protections
- Your insurer is required to pay out-of-network providers and facilities directly.
- Your insurer must count any amount you pay for emergency services or certain out-of-network services (described above) toward your in-network deductible and out-of-pocket limit.
- Your provider, facility, hospital, or agency must refund any amount you overpay within sixty days of being notified.
- No one, including a provider, hospital, or insurer can ask you to limit or give up these rights.
If you want to file a complaint against a health care provider, you can submit an online complaint by visiting this website: https://www.colorado.gov/pacific/dora/DPO_File_Complaint. If you think you have received a bill for amounts other than your copayments, deductible, and/or coinsurance, you can contact the billing department, or the Colorado Division of Insurance at 303-894-7490 or 1-800-930-3745. You can contact your health insurance plan at the number on your health insurance ID card or the Colorado Division of Insurance with questions.
If You Do Not Have Insurance
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services in advance. Here are some important things to know about that:
Important: Good faith estimates show the cost of items and services that are reasonably expected for your health care needs while receiving healthcare services. The estimate is based on information known at the time the estimate is created, but it may not be exact.
You can find more information about the Good Faith Estimate requirements here.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services in advance. Here are some important things to know about that:
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a medical/mental health item or service at least 3 business days before the date you will receive the item or service, you must be given a good faith estimate no later than 1 business day after scheduling.
- If you schedule a medical/mental health item or service at least 10 business days before the date you will receive it, or request cost information about an item or service, the provider or facility must give you a good faith estimate no later than 3 business days after scheduling or requesting.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
Important: Good faith estimates show the cost of items and services that are reasonably expected for your health care needs while receiving healthcare services. The estimate is based on information known at the time the estimate is created, but it may not be exact.
You can find more information about the Good Faith Estimate requirements here.