Review draft — not an adopted public notice. Facility approval and completion are required before publication.
What is balance billing?
When you see a health care provider, you may owe copayments, coinsurance or a deductible. You may owe more when a provider or facility is out of network, meaning it does not have a contract with your health plan. Balance billing is billing you for the difference between a provider's charge and the amount allowed by your plan. Surprise billing is an unexpected balance bill.
When are you protected?
Emergency services: For emergency care covered by these federal protections, an out-of-network provider or facility cannot charge more than your in-network cost-sharing amount. Protections also apply to most post-stabilization services unless the legal conditions for notice and consent are satisfied. This notice does not mean that OrthoSurg ASC provides emergency department services.
Certain services at an in-network hospital or ambulatory surgical center: When you receive care at an in-network facility, certain out-of-network providers may not balance bill you. This includes emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist and intensivist services covered by the law. These providers cannot ask you to waive these protections.
For other covered services at an in-network facility, an out-of-network provider generally may not balance bill unless you voluntarily give valid written consent after receiving the required notice. You are never required to give up your protections or obtain out-of-network care. These rules do not protect every service or every visit to an out-of-network facility.
What does your health plan have to do?
When balance billing is prohibited, you are responsible only for the in-network cost-sharing amount. Your plan generally must cover emergency services without prior authorization, cover qualifying out-of-network emergency services, calculate your cost share under the required in-network rules, and apply that cost share to your in-network deductible and out-of-pocket limit. Your plan and the provider are responsible for resolving their payment dispute.
Questions or an unexpected bill?
Call the center at 812-401-9171. For federal protections or a suspected violation, call the No Surprises Help Desk: 1-800-985-3059 or visit cms.gov/nosurprises.
For questions about Indiana-regulated insurance and applicable state protections, contact the Indiana Department of Insurance at 1-800-622-4461 or in.gov/idoi/consumer-services. State protections and the agency that handles your concern can depend on your coverage. This draft must be supplemented with any additional applicable Indiana balance-billing protections identified in the facility's legal review.
If you do not have insurance or are not using it, you may have a right to a Good Faith Estimate of expected charges.