Know Your Rights: Read About the No Surprises Act
The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.
Starting in 2022, there are new protections that prevent surprise medical bills. If you have private health insurance, these new protections ban the most common types of surprise bills. If you’re uninsured or you decide not to use your health insurance for a service, under these protections, you can often get a good faith estimate of the cost of your care upfront, before your visit. If you disagree with your bill, you may be able to dispute the charges.
What are surprise medical bills?
Before the No Surprises Act, if you had health insurance and received care from an out-of-network provider or an out-of-network facility, even unknowingly, your health plan may not have covered the entire out-of-network cost. This could have left you with higher costs than if you received care from an in-network provider or facility. In addition to any out-of-network cost sharing you might have owed, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid, unless banned by state law. This is called “balance billing.” An unexpected balance bill from an out-of-network provider is also called a surprise medical bill. People with Medicare and Medicaid already enjoy these protections and are not at risk for surprise billing.
Click here to continue reading about the No Surprises Act.
Still have questions? Visit www.cms.gov/nosurprises for more information.
Some medical procedures require pre-authorization from your insurance company. We will assist your doctor’s office in obtaining pre-authorization as needed. Insurance carriers who require preauthorization for imaging procedures require that your doctor provide the insurance company with some clinical information concerning your medical condition and, sometimes, prior treatments. If your plan is not listed below as a Participating Health Plan, it is your responsibility to get preauthorization, not your doctor. A partial list of common procedures requiring preauthorization can be found below.
Please work with your doctor and insurance company to ensure your preauthorization, when required, is received by Jefferson Radiology before your scheduled exam.
Without your insurance carrier’s preauthorization number you may become fully financially responsible for any services rendered or your appointment time may need to be rescheduled. Our Preauthorization Department can be reached at 860-289-3375 from 8:30 AM until 5:00 PM Monday through Friday to assist you and your doctor’s office.
Imaging exams usually requiring preauthorization are, but not limited to:
- CT scans (all diagnostic exams)
- MRI/MRA (all examinations)
- Nuclear Cardiology
- Bone Densitometry Tests
Jefferson Radiology will assist you in resolving your insurance questions with regard to our services. If necessary, our billing team can establish a payment plan to help you meet your financial responsibility.
Just because something is a covered benefit on a health insurance plan doesn’t mean it’s free. Here’s the difference between care that’s covered-in-full, covered, or not covered.
This means a benefit is paid entirely by your plan. In other words, it’s free for you! Some examples include your annual physical, some kinds of primary care depending on your health history, your annual well-woman description below (OB-GYN) exam, an annual flu shot, many immunizations, and certain types of birth control.
These benefits are paid for according to your plan’s rules for cost-sharing. If you have a deductible, you’ll pay the bill at the negotiated rate and it will count toward your deductible and out-of-pocket max. If you met your deductible but not your max, you might owe a copay or coinsurance. How much you’ll pay depends on your plan and the services you received.
These services are not paid for at all by your health insurance plan. Examples of services that aren’t typically covered are services with providers who aren’t in your network, services that aren’t medically necessary, or drugs that aren’t in the formulary. Keep in mind that any money you pay for services that are not covered will not count toward your deductible or your out-of-pocket max.
Diagnostic Imaging Billing Practices
Unlike other imaging centers, Jefferson Radiology offers both facility and reading services. This means that your visit includes both the administration of your imaging exam and the interpretation of your images by one of our radiologists. Depending on where your imaging exam is performed, you may receive two separate billing statements:
Global Billing: Under global billing, patients will receive a single bill with the total of their final costs. The statement includes both the taking and reading of images. An exam performed at any of Jefferson Radiology’s nine imaging centers falls under this category.
Professional Billing: Under professional billing, patients will receive two separate statements that together will amount to the final cost of their visit. This is because Jefferson Radiology oversees ONLY the reading of images. For example, when you visit one of Jefferson Radiology’s affiliated hospitals, you will receive one billing statement from us for the reading of your images and you will receive a separate billing statement from the affiliated hospital for the taking of your images.