Your Rights and Protections Against Surprise Medical Billing
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”.
NOTE: Light at the End, LLC therapy services does not provide emergency services and only provides outpatient mental health care.
What is “balance billing” (or “surprise billing”)
When you see a doctor or other health care provider, you may owe certain out of pocket costs, such as 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 healthcare facility that isn’t in your health plan’s network.
NOTE: Light at the End, LLC therapy services requires payment prior to services being rendered and does not bill after an appointment unless payment was not received or was revoked by you for any reason.
“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 out-of-pocket limit.
NOTE: Light at the End, LLC therapy services is out of network with all insurance. Full payment is expected prior to services rendered.
“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.
NOTE: Light at the End, LLC therapy services requires payment prior to services being rendered and does not bill after an appointment unless payment was not received or was revoked by you for any reason. You have complete control over the choice to utilize Light at the End, LLC therapy services.
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 cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up protections not to be balance billed for these post-stabilization services.
Florida State laws about balance billing restrict balance billing and require coverage by your insurance in a similar manner and the new Federal law expands those protections. More information can be located by researching Florida Statute 627.64194.
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 out-of-network care. You can choose a provider or facility in your plan’s network.
NOTE: Light at the End, LLC therapy services only provides outpatient nonemergency mental health therapy services and is out-of-network with all insurance providers.
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 that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly for emergency services.
NOTE: When you choose Light at the End, LLC therapy for your mental health services you are choosing not to use any in-network coverage and accepting the full rate for services chosen. All fees are explained and collected prior to services being rendered.
Your health plan generally must:
Cover emergency services without requiring you to get 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 services or out-of-network services toward your deductible and out-of-pocket costs.
If you believe you’ve been wrongly billed, you may contact Contact the Florida Office of Insurance Regulation at 850.413.3140, or visit the Florida Office of Insurance Regulation for more information about your rights under state laws.
Visit https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/no-surprises-act for more information about your rights under federal law.
Visit http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0627/Sections/0627.64194.html for more information about your rights under Florida State law.