We encourage you to contact the business office prior to surgery for an estimate of your charges.
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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 health care 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of network provider or facility, the most they 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.
If emergency services are provided by a nonparticipating provider, with or without prior authorization, the health plan company shall not impose coverage restrictions or limitations that are more restrictive than apply to emergency services received from a participating provider. Cost-sharing requirements that apply to emergency services received out-of-network must be the same as the cost-sharing requirements that apply to services received in-network.
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 types of 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 care out-of-network. You can choose a provider or facility in your plan’s network.
An in-network provider is permitted to bill an enrollee for services not covered by the enrollee’s health plan as long as the enrollee agrees in writing in advance before the service is performed to pay for the noncovered service.
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 any additional costs to out-of-network providers and facilities directly.
Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as “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 in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, you may contact
The Office of the Minnesota Attorney General: https://www.ag.state.mn.us/Office/Forms/ConsumerAssistanceRequest.asp or call (800) 657-3787
Centers for Medicare & Medicaid Services:
https://www.cms.gov/nosurprises/consumers/payment-disagreements or call (800) 985-3059
For more information about your rights under federal law visit https://www.cms.gov/nosurprises
Right To Receive Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care 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 health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care 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.
For questions or more information about your right to a Good Faith Estimate, visit https://www.cms.gov/nosurprises or call 1-877-696-6775.
Good Faith Estimate Disclaimer
This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.
The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.
You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.
There is a $25.00 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
For Questions or more information about your right to a Good Faith Estimate or the dispute process and dispute forms, visit www.cms.gov/nosurprises or call 1-877-696-6775.
If you have insurance:
We encourage you to contact your insurance provider to review your benefits and estimated financial responsibility before surgery.
We will bill your insurance company for you. Please keep in mind that the billing of your insurance coverage is done as a courtesy, and the responsibility for referrals, prior authorizations and payment remains with you.
If your procedure is excluded from coverage (e.g. cosmetic, experimental, pre-existing, etc.) we will ask for half of the estimated amount due prior to services being rendered. You will be asked to sign a promissory note for the remainder to be paid in three monthly payments.
In addition, we may ask for payment in full for supplies or implants not covered by your insurance such as cataract lens implants.
If you do not have insurance:
We will ask you for half of the estimated amount due for services prior to services being rendered. You will be asked to sign a promissory note for the remainder to be paid in three monthly payments.
The Mankato Surgery Center contracts with other third party healthcare providers for certain aspects of your care. In addition to the charges from your physician and the Surgery Center, you may receive statements from the following contracted providers:
- Laboratory: For physician-requested blood work.
- X-ray Studies: For radiologist reading services from either the Surgery Center or another facility, whichever took your X-rays for your procedure.
- Pathology: For tissue analysis from both the facility that prepares the slides and from the doctor who reads them. Mankato Surgery Center physicians may use LCM, Mankato Clinic, Allina Health, or Mayo Clinic Health System in Mankato laboratories to process your tissue. Mankato Surgery Center does not have a lab, X-ray or pathology department/services on site.
If you have questions on payment of the above services you may need to call your insurance company to confirm reimbursement.
Statements & Payments:
Mankato Surgery Center bills for facility fees and anesthesia professional fees. The facility fees are billed separately from the anesthesia fees and you may receive two statements from Mankato Surgery Center.
- You will receive your first statement after we have received payment from your insurance company. If you do not have insurance you will receive it a few days after your procedure.
- All services are to be paid in full within 90 days from date of your first statement. Finance charges accrue after 90 days on any unpaid balance.
- If you need to set up a payment plan, please contact the Business Office as soon as possible.
- We accept payment by check, credit card or cash.
- You may make online payments by selecting “Make A Payment” button from the menu.
- We can also process these payments over the phone.
- If you have any questions on our payment policies or would like an estimated cost of your surgery, please call our business office at 507.388.6000.
Your health care provider is referring you to a facility in which Mankato Clinic and the Orthopaedic and Fracture Clinic have a financial or economic interest.