Your Rights and Protections Against Surprise Medical Bills
As of January 1, 2022, when you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
WHAT IS “BALANCE BILLING” (SOMETIMES CALLED “SURPRISE BILLING’) ?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a co-payment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
YOU ARE PROTECTED FROM BALANCE BILLING FOR:
- Emergency services
If you have an emergency medical condition and get emergency services from 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 co-payments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
- Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
HOW DOES THE NO SURPRISE ACT AFFECT DR. FEDERICI'S PRACTICE ?
Dr. Federici does not see people at hospitals or ambulatory surgical centers. Before the initial appointment each patient, or their parent, speaks personally with Dr. Federici on the phone. They are advised of the fee for the session and that Dr. Federici does not participate in any insurance plans. Patients are expected to pay for each session in full at the time of service. Upon receipt of payment, Dr Federici will provide a receipt for your records, which is suitable for submission to your insurance company. As discussed in the Consent for Therapy Agreement, you are fully responsible for each session’s fees, regardless of what your insurance may or may not cover. Dr. Federici, and Dr. Richard Federici, LLC are not subject to the requirements of The No Surprise Act and are NOT REQUIRED to provide Estimate Billing Documentation.
DR. RICHARD FEDERICI