DISCLAIMER: CLIENT’S RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
IMPORTANT: PLEASE READ CAREFULLY BEFORE USING OUR SERVICES.
This disclaimer outlines important information regarding your rights and protections against surprise medical bills as provided under the No Surprise Act. By engaging our services, you acknowledge and agree to the following terms and conditions. If you do not agree with these terms, please refrain from using our services.
Purpose of Disclaimer
This disclaimer aims to inform you of your rights and protections against surprise medical bills as mandated by the No Surprise Act. It is essential to understand your rights to make informed decisions about your healthcare and financial obligations.
Balance Billing and Surprise Medical Bills
The No Surprise Act protects you from surprise billing or balance billing, which occurs when you receive care from an out-of-network healthcare provider and are billed for the difference between their charges and what your insurance plan covers. The Act provides the following key protections:
- Emergency Services: In the event of an emergency medical condition, you cannot be balance billed by an out-of-network provider or facility. The most the provider or facility may bill you is your plan’s in-network cost-sharing amount, such as copayments and coinsurance.
- In-Network Facilities: When receiving services from an in-network hospital or ambulatory surgical center, certain providers within these facilities may be out-of-network. These providers, including emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services, cannot balance bill you. You are only responsible for your plan’s in-network cost-sharing amount.
Consent and Protections
Under the No Surprise Act, you are not required to give up your protections against balance billing. You have the right to choose providers or facilities within your insurance plan’s network to ensure full protection. Out-of-network providers cannot balance bill you unless you provide written consent to waive these protections.
Cost-sharing and Coverage
Your health plan is required to provide the following protections under the No Surprise Act:
- Cover emergency services without prior authorization.
- Cover emergency services provided by out-of-network providers.
- Calculate your cost-sharing based on what it would pay an in-network provider or facility and clearly state this amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
Dispute Resolution and Assistance
If you believe you have been wrongly billed or have concerns regarding surprise medical bills, please contact our office. We will provide assistance and guide you on how to resolve any billing issues in compliance with the No Surprise Act.
Updates and Additional Information
The information provided in this disclaimer is based on current understanding and interpretation of the No Surprise Act. Please note that laws and regulations are subject to change, and this disclaimer may be updated accordingly. For the most up-to-date information and further details regarding your rights under the Act, refer to the official sources or consult legal counsel.
By continuing to use our services, you acknowledge that you have read and understood this disclaimer and agree to the rights and protections provided by the No Surprise Act.
Visit https://www.cms.gov/nosurprises/policies-and-resources/overview-of-rules-fact-sheets for more information about your rights under Federal law.