No Surprise Billing Act

Your Rights and Protections Against Surprise Medical Bills

Providing this notice as required by the federal No Surprises Act. This notice may pertain to services provided by Compassionate Concierge Physicians.

When you receive  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. Inthese cases, you shouldn’t be charged more than your plan’s copayments, coinsuranceand/or deductible.

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,like a copayment, coinsurance, or deductible. You may have additional costs or have to pay theentire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. 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. 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.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who isinvolved 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 medical bills could cost thousands of dollars depending on the procedure or service.

‍

You’re 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 they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You cannot 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.In addition to the protections under federal law, Colorado law prohibits balance billing for emergency care from facilities or providers that are out-of-network, for those patients with state regulated health plans.

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 can 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.

If you receive other types of services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.

You’re never required to surrender  your protections from balance billing. You also aren’t required to receive out-of-network care. You can choose a provider or facility in your plan’s network.

In addition to the protections under federal law, Colorado law prohibits balance billing for nonemergency care provided by an out-of-network provider at an in-network facility without consent, for those patients with state-regulated health plans.

‍

When Balance Billing Isn’t Allowed, You Also Have These Protections :