In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. Certain services at an in-network hospital or ambulatory surgical center If your insurance ID card says “fully insured coverage,” you can’t give written consent and give up your protections not to be balance billed for post-stabilization services. This includes services you may get after you’re in a stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. You can’t be balance billed for these emergency services. If you have an emergency medical condition and get emergency services from an out-of-network provider or hospital, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You’re Protected from Balance Billing for: Emergency Services Surprise medical bills could cost thousands of dollars depending on the procedure or service. 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. “Surprise billing” is an unexpected balance bill. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. You may have additional 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. When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. What is “Balance Billing” (Sometimes Called “Surprise Billing”)? In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance, and / or deductible. When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. Plan participation for physicians employed by Mather Hospital can be found here.Ĭontact information for physicians groups the hospital has contracted with can be found here.Your Rights & Protections Against Surprise Medical Bills You will want to check with the physician arranging for your hospital services to determine what plans that physician participates in. Physicians bill separately for their services and may or may not participate in the same plans as the hospital. Please note that physician services you receive in the hospital are not included in the hospital’s charges. If you do not see your plan listed or you have any questions, please call our Insurance Verification Office at 63. You may want to contact your health insurance provider or refer to your health insurance provider’s member services section of their website for further information. This list is based on the most current information provided by each health insurance provider. Mather Hospital accepts or participates with all payers listed below, except as indicated.
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