Your Rights and Protections Against Surprise Medical Bills
When you receive care from an audiologist or healthcare provider, we believe you deserve absolute clarity regarding what your services will cost. The federal No Surprises Act is designed to protect patients from unexpected financial burdens when receiving medical care.
At Martina Audiology, we are fully committed to financial transparency, ensuring you are never caught off guard by unexpected out-of-network costs or hidden fees.
What is “Balance Billing” (Surprise Billing)?
When you see a healthcare provider, your health insurance plan may help cover the costs.
- In-Network: If a provider has a contract with your insurance company, they are “in-network” and have agreed to set rates for their services.
- Out-of-Network: Providers who haven’t signed a contract with your health plan are “out-of-network.” They may bill you for the difference between what your insurer pays and the full cost of the service. This is called balance billing (or surprise billing).
This unexpected expense often happens when you cannot control who is involved in your care.
Your Protections Under the Law
You are protected from balance billing for non-emergency services.
If you receive scheduled care or diagnostic testing, an out-of-network provider cannot balance bill you unless you give explicit, written consent to waive your protections. You are never required to waive these protections, and you always have the right to choose an in-network provider.
When balance billing protections apply, you also receive these benefits:
- Cost-Sharing Limitations: You are only responsible for paying your standard, in-network share of the cost (such as your typical copayments, coinsurance, or deductibles).
- Direct Insurance Payments: Your health plan is required to pay any additional out-of-network costs directly to the provider.
- Deductible Credits: Any amount you pay for these covered services must count directly toward your primary insurance plan’s in-network deductible and out-of-pocket limits.
The Right to a “Good Faith Estimate”
If you do not have health insurance, or if you choose not to file a claim through your insurance provider (self-pay patients), you have the right to receive a Good Faith Estimate before your scheduled appointment.
- We will provide this detailed estimate of expected costs in writing at least one business day before your service is scheduled.
- You can also request a comprehensive cost estimate at any time before scheduling an appointment.
- If you receive a final bill that is $400 or more above your Good Faith Estimate, the law grants you the right to formally dispute the charges.
Questions or Concerns?
If you believe you have been incorrectly billed, or if you have questions about your consumer rights under federal law, you can contact the official No Surprises Help Desk managed by the Centers for Medicare & Medicaid Services (CMS):
Online: www.cms.gov/nosurprises/consumers
Phone: 1-800-985-3059