Protection Against Balance Billing
The No Surprises Act takes effect on January 1, 2022 and provides patients financial protections against surprise medical bills, and prohibits balance billing for certain out-of-network (OON) care.
AIO will provide patients a disclosure notice which describes in clear and understandable language the protection against balance billing.
AIO will provide “uninsured” or “out-of-network” patients a “Good Faith Estimate” of charges for services requested who have a scheduled appointment at our offices.
Right to Receive Good Faith Estimate
You have the right to receive a “Good Faith Estimate: explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you received a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or a picture of your Good Faith Estimate
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
State Specific Disclosure Notice for Patients
We are also happy to conduct your visit via a telehealth visit using video technology or phone if you do not have a camera equipped device. Please call our main number at 1-888-634-9800 to schedule a telehealth visit.
Frequently Asked Questions
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, 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 provides your care. Emergency care or being treated by an out-of-network provider at an in-network clinic are examples of when they may occur.
No. Out-of-pocket costs of copays, deductibles, and coinsurance are part of the benefit design with your health coverage and you are expected to pay these amounts up to the out-of-pocket maximum limit defined by your coverage. Note that in-network benefits can differ significantly from out-of-network benefits. You may have higher out-of-pocket costs if your coverage is considered out-of-network at Associates in Ophthalmology.
No. But you will likely pay higher out-of-pocket costs when seeing an out-of-network provider.
Please contact our finance office at 412-653-3080 Option #6.