“Dr. Runk coming into my life and taking care of me was meant to be. She’s definitely the reason that I’m still here with my family today.”
— Kelly R.
Cincinnati Breast Surgeons (Seven Hills OB/GYN Associates) – a community of caring, connected, progressive health professionals committed to giving women more – is providing this notice as required by the federal No Surprises Act.
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional 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” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 plan’s deductible or 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You cannot 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.
In addition to the protections under federal law, Ohio law prohibits balance billing for emergency care by out-of-network facilities or providers, for those patients with state-regulated health plans.
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 can 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 types of services at these in-network facilities, out-of-network providers cannot
balance bill you, unless you give written consent and give up your protections.
In addition to the protections under federal law, Ohio law prohibits balance billing for non- emergency care provided by an out-of-network provider at an in-network facility without consent, for those patients with state-regulated health plans.
Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Visit https://insurance.ohio.gov/wps/portal/gov/odi/consumers/health/surprise-billing for more information about your rights under Ohio law.