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. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance, and/or deductible.
+ What is "balance billing" (sometimes called "surprise billing")?
+At Woodlands Sports Medicine Centre you're protected from balance billing for:
-When balance billing isn't allowed, you also have these protections:
You're only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
Generally, your health plan must:
• Cover emergency services without requiring you to get approval for services in advance (also known as "prior authorization").
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.
Need an Estimate?
You have the right to receive a "Good Faith Estimate"
explaining
how much your medical care will cost. For more information please email your request to our billing department via email at billing@woodlandssportsmedicine.com or via fax at 281-887-8367.
If you have a state of Texas regulated insurance plan or nave coverage through the Texas employee or teacher Retirement System, then you may have additional protections regarding surprise medical bills. For more information, please visit https://www.tdi.texas.gov/medical-billing/index.html (https://www.tdi.texas.gov/medical-billing/index.html).
For information or assistance with balance billing questions from the State of Texas Department of Insurance, visit https://www.tdi.texas.gov/medical-billing/surprise-balance-billing.html (https://www.tdi.texas.gov/medical-billing/surprise-balance-billing.html).
Visit http://www.cms.gov/nosurprises (http://www.cms.gov/nosurprises) for more information about your rights under federal law. The federal phone number for information and complaints is: 1-800-985-3059
Request an Estimate
You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost:
- Under the law, healthcare 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. - You should receive a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive 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 picture of your Good Faith Estimate.
Requesting an Estimate:
we are happy to provide estimates for services for patients who don't have insurance or who are not using insurance. In order to enhance accuracy, when you request an estimate, please provide the procedure code (CPT) and the diagnosis code (ICD-10) for the services that are of interest.
This information can be provided to you by your physician or clinic and is important to ensure you are being provided an estimate for the appropriate treatment or procedure.
Please email your request to billing@woodlandssportsmedicine.com.
Once the information is provided, you will receive a response in 2-3 business days.
* Please keep in mind that communications via email over the Internet are not secure. Although it
is unlikely, there is a possibility that information you include in an email can be intercepted and read by other parties besides the person to whom it is addressed.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises (http://www.cms.gov/nosurprises)
