Surprise Bills

Sometimes, Fidelis Care members at network hospitals or ambulatory surgical centers will receive health services from providers who do not participate in the Fidelis Care Network. In this case, the resulting bill is NOT always considered a surprise bill. 

If you go to a network facility, but receive care from an out-of-network doctor, it's only a surprise bill if:

• A participating doctor was not available; or 
• A non-participating doctor provided services without your knowledge; or 
• Unforeseen medical circumstances arose at the time the healthcare services were provided. 

It is NOT a surprise bill if you chose to receive services from a non-participating doctor instead of from an available participating doctor. 

Examples of surprise bills include, but are not limited to, the following:

• Your blood is drawn in a network doctor's office, but the blood is sent to a non-participating laboratory without your explicit written consent. 
• You are admitted to the hospital. During that hospital stay, consultation services are provided by specialists who do not participate with Fidelis Care, AND either: 
  • a network doctor is unavailable; OR 
  • an out-of-network doctor provides services without your knowledge; OR 
  • unforeseen health needs arise at the time services are rendered. 

A referral to a non-participating provider occurs when:

• During the course of a visit with your network doctor, an out-of-network provider treats you; or 
• Your participating doctor takes a specimen from you in the office (for example, blood) and sends it to a non-participating laboratory or pathologist; or 
• For any other healthcare services when referrals are required under your plan. 

You will be protected from a surprise bill and you will only be responsible for your in-network copayment, coinsurance or deductible if you: 

• Sign an assignment of benefits form to permit your provider to seek payment for the bill from your health plan; AND
• Send one copy of the form to your provider and include the bill(s) you do not think you should pay. Also send a copy of the form and bill via hard copy to: 

Fidelis Care 
Attention: Member Services 
95-25 Queens Boulevard 
Rego Park, New York 11374 

Fidelis Care must protect you from bills for out-of-network emergency services in a hospital. You do not have to pay non-participating provider charges for emergency services (typically for services in a hospital emergency room) that are more than your in-network copayment, coinsurance or deductible. Let Fidelis Care know if you receive a bill from a non-participating provider for emergency services.