2 anesthesiology; (C) laboratory and pathology services; (D) radiology; (E) neonatology; (F) diagnostic services; (G) assistant surgeons; (H) Hospitalists; (I) Intensivists; and (J) any services set out by the U.S. Department of Health & Human Services. Out-of-Network Providers satisfy the notice and consent requirement as follows: 1. By obtaining your written consent not later than 72 hours prior to the delivery of services; or 2. If the notice and consent is given on the date of the service, if you make an appointment within 72 hours of the services being delivered. Out-of-Network Air Ambulance Services When you receive Covered Services from an Out-of-Network Air Ambulance Provider, your Out-of-Pocket costs will be limited to amounts that would apply if the Covered Service had been furnished by an In- Network Air Ambulance Provider. How Cost shares Are Calculated Your cost shares for Surprise Billing Claims will be calculated based on the Recognized Amount. Any Out-of-Pocket cost shares you pay to an Out-of-Network Provider for either Emergency Services or for Covered Services provided by an Out-of-Network Provider at an In-Network Facility or for Covered Services provided by an Out-of-Network Air Ambulance Service Provider will be applied to your In- Network Out-of-Pocket Limit. Appeals If you receive Emergency Services from an Out-of-Network Provider, Covered Services from an Out-of- Network Provider at an In-Network Facility, or Out-of-Network Air Ambulance Services and believe those services are covered by the No Surprise Act, you have the right to appeal that claim. If your appeal of a Surprise Billing Claim is denied, then you have a right to appeal the adverse decision to an Independent Review Organization as set out in the “Your Right to Appeal” section of this Benefit Book. Provider Directories Anthem is required to confirm the list of In-Network Providers in its Provider Directory every 90 days. If you can show that you received inaccurate information from Anthem that a Provider was In-Network on a particular claim, then you will only be liable for In-Network cost shares (i.e., Copayments, Deductibles, and/or Coinsurance) for that claim. Your In-Network cost shares will be calculated based upon the Maximum Allowed Amount. Transparency Requirements Protections with respect to Surprise Billing Claims by Providers, including information on how to contact state and federal agencies if you believe a Provider has violated the No Surprises Act. You may also obtain the following information on Anthem’s website or by calling Member Services at the phone number on the back of your ID card: • Cost sharing information for covered items, services, and drugs, as required by the Centers for Medicare & Medicaid Services (CMS); and • A listing / directory of all In-Network Providers. In addition, Anthem will provide access through its website to the following information: