Your Rights and Protections Against Surprise Medical Bills

You are protected from surprise billing or balance billing when you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center.

This does not apply to non-emergency services when the hospital is also out-of-network.

Newborn Specialists of Tulsa is a physician group that bills separately from the hospital where you or your newborn may have been treated. Since we are separate from the hospital, we may or may not be contracted with the same insurance plans as the hospital. There is a chance that our physicians may be out-of-network, even if the hospital is in-network. Suppose you have obtained care at an in-network hospital, but our physicians are out-of-network. In that case, you will only be responsible for your deductible, co-pay, or coinsurance as determined by the EOB from your insurance plan. We cannot "balance bill" for any amount over the amount your insurance allows. Please see the information below about "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 copayments, coinsurance, or a deductible. You may have additional costs or must pay the entire bill if you see a provider or visit a healthcare facility that isn't in your health plan's network.

"Out-of-network" describes providers and facilities without a contract with your health plan. Out-of-network providers may bill you for the difference between your plan's agreement and the total 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 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:

Emergency services

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 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 that 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 your bill 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 only balance the bill for you if 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:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles you would pay if the provider or facility were in-network).
• Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
  • Cover emergency services without requiring approval for services in advance (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 or out-of-network services toward your deductible or out-of-pocket limit.

We aim to comply with the No Surprise Billing Act at Newborn Specialists of Tulsa. If you believe you are being incorrectly billed for out-of-network balances, please contact our office at (918) 205-0715 or message us through our website.

If you are not satisfied with our response, for further information or to file a complaint, you may call Consumer Complaints at 1-800-985-3059 or go to https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills