Ability Health and Rehabilitation, LLC
10101 W. Overland Rd., Suite 110
Boise, ID 83709
208-333-9578 (Office)
208-333-9582 (Fax)
Patient Financial Information No-Suprises Act
INSURANCE
1. Your insurance coverage is a contract between you and your insurance company. We are not a party to that contract.
2. Our fees generally fall within the range allowed by most companies and, therefore, are covered up to the maximum allowance determined by each carrier. To verify your coverage, this office will contact your insurance company. This does not guarantee payment of services.
3. Not all services are covered benefits in all contracts. It is your responsibility to learn from your insurance company what it will or will not cover under your contract. We must
Emphasize: our relationship is with YOU not your insurance company. While the filing of insurance claims is a courtesy, which this office extends to the patients, all charges are your responsibility; and it must be paid within thirty (30) days from the time services are rendered.
PAYMENTS
This office will file claims to the patient’s primary insurance company only for reimbursement, but the patient will be responsible for making the required copayment at the time of service. For self-pay patients, full payment is expected at the time of service. We accept cash, cashier’s checks, certified checks, personal checks, credit/debit cards and money orders. If your payment is returned because of insufficient funds, a charge of 20.00 will be added to your account. We will not release your records to other providers if you have an outstanding balance. Your account needs to be kept current unless other arrangements have been made.
APPOINTMENTS/PRESCRIPTIONS
We make every effort to allow ample time for every patient, as quality of care is very important. It will be your responsibility to contact this office 24 hours in advance if you are not able to keep your appointment. Appointments that are not cancelled 24 hours before the appointment time may incur a charge of $50.00. Telephone contact with the provider matching and/or exceeding the allotted duration or resulting in changes in medications may incur a charge of $35.00. Requests for prescriptions of controlled medications outside an appointment with your provider may incur a charge of $10.00. As a courtesy, this office will verify your appointments one day before using the telephone numbers you have provided. However, keeping your scheduled appointments is your responsibility. Because we want to provide you with the utmost privacy regarding your visits, please be sure you provide us with phone numbers where we may leave a message regarding your appointment if you are unavailable.
No Suprises Act (NSA)
Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for innetwork cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.
Billing Disclosures – Your Rights and Protections 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 healthcare 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: 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 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 hose 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 protection 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 that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by outof-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-ofnetwork services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact
The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit https://www.cms.gov/nosurprises for more information about your rights under federal law.
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.
- Make sure your healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
