Your Rights and Protection Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
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, 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 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.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t 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.
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 may 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 get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
Center Street Community Health Center complies with applicable Federal and State of Ohio laws including House Bill 388 Revised Code 3902.50; 3902.52; 3902.52; 3902.53; 3902.54.
If you believe you’ve been wrongly billed, you may contact the Departments of Health and Human Services, Labor, and Treasury at 1-800-985-3059
Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Visit https://insurance.ohio.gov/wps/portal/gov/odi/home for more information about your rights under Ohio laws.
Download a printable version of the insured patient information
You Have the Right to Receive a “Good Faith Estimate” Explaining How Much Your Medical Care Will Cost
Under the No Surprises Act, health care providers are required to give patients who don’t have insurance or who are not using insurance an estimate of the bill for scheduled medical items and services.
For questions or more information about your right to a Good Faith Estimate, or to dispute your bill, visit www.cms.gov/nosurprises or call 1-800-985-3059
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After Hours on-call provider: 614-365-2669
Para contactar al doctor des pues de horas de trabajo en espanol, favor llamar al: 614-365-2669
136 West Center Street,
Marion, Ohio 43302
Hours: Monday - Friday 8 am - 6 pm