Yes. Federal law requires any health plan providing benefits for emergency services to cover them even if a particular health care provider or hospital is not in your insurance plan’s network. In addition, your plan can’t charge you a copayment or coinsurance on emergency services provided out-of-network that is greater than what it would charge if the services were provided in-network. However, in some states that allow balance or surprise billing, an out-of-network provider can charge you the difference between what the insurance company has paid and what the provider has charged. In this case, you may face higher out-of-pocket costs for emergency care.

You have the right to ask your plan to reconsider its decision. If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an external review.

If you’re not satisfied with the way your insurance company addresses your appeal or if you need help, every state has an insurance department you can contact about your coverage. To find out more, contact your state insurance department. Your state may also have a consumer assistance program that can help you file an appeal. Ask your state insurance department if your state has such a program. Finally, contact the National Patient Advocate Foundation  on their website or (800) 532-5274, may also be able to help you file an appeal with your insurance company.

If you’re not satisfied with your health plan’s services or if your claim has been denied, call the member services phone number on your health plan member card. You may be able to resolve your concern over the phone, or you or your representative can file a complaint with the health plan.

If you decide to file a complaint, you may need to complete a form and submit it in writing so the health plan can investigate the facts, decide what to do and share any action being taken to address your complaint. You should receive a letter that explains how your complaint was resolved. It will include your appeal rights and how to submit an appeal if you want the health plan to reconsider its decision.

If you’re not satisfied with how your insurance company addresses your complaint, every state has an insurance department to help with questions or complaints. To find out more, contact your state insurance department. Ask if your state has a consumer assistance program that can help you file an appeal. The National Patient Advocate Foundation may be able to help you file an appeal or resolve billing or other complaints with your insurance company. You can also call them at (800) 532-5274.