Answer three quick questions about one out-of-network claim. You’ll get a preliminary result right away, and you can send it to us for a full review.
Emergency care, care after an emergency visit, scheduled care at an in-network hospital or ASC, and air ambulance are covered. Ground ambulance is not.
For emergency care, the provider or the facility being out of network is enough. For scheduled care, the facility has to be in network and the provider group out of network; care at an out-of-network facility or office isn’t covered.
Commercial plans are covered. Medicare (including Medicare Advantage) and Medicaid are not.
Everything else, like state law, how the plan handled the claim and the filing deadlines, we check from your records in the full review. Rules: 45 CFR Part 149 and CMS No Surprises Act resources. Equavis Health isn’t a certified IDR entity; this tool is a preliminary screen, not legal advice.