You get emergency care or treatment from an out-of-network provider at an in-network hospital or ambulatory surgical center. Then you are protected from surprise billing or balance 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.
If The Integrated Wellness Center is not in-network with your insurance, and you want in-network coverage, you can choose a provider or facility in your plan’s network.
If you want in-network rates, and we are not in-network for your insurance, you will likely be referred to a different office or clinic than The Integrated Wellness Center, as we do not accept every insurance at our office.
If you are seen at The Integrated Wellness Center, and are out of network, we will use balance billing. It will follow the fee schedule included in our outpatient service contract.
We will provide a detailed list of expected charges for your services.
It is likely that your provider will overestimate the cost of services to provide you with the maximum expected out-of-pocket cost for treatment.
This estimate is based on information known at the time the estimate was created. If additional services are recommended, a new estimate will be presented to you for your signature.
Estimated costs are valid for 12 months after the date of the Good Faith Estimate. The Good Faith Estimate is not a contract, and signing it does not obligate you to obtain the services estimated. Please talk with your provider about the estimate if you have questions or concerns.
The Good Faith Estimate is an estimate and may not include any unknown or unexpected costs that may arise during treatment. Therefore, actual items, services, and charges may differ from the Good Faith Estimate. If this happens, federal law allows you to dispute (appeal) the bill.