Billing Disclosures

Billing Disclosures — Your Rights and Protections Against Surprise Medical Bills (No Surprises Act)

Effective January 1, 2022, the federal No Surprises Act protects patients from most surprise (balance) bills for emergency services at out-of-network facilities and for out-of-network providers at in-network facilities. It also gives uninsured or self-pay patients the right to a Good Faith Estimate of expected charges before non-emergency care.

This notice applies to care you receive from Mid Ohio Digestive Diseases Associates (MODDA) and to services we coordinate at hospitals or ambulatory surgery centers.
Clinic address: 99 Brice Rd N N, Columbus, OH 43213, USA • Phone: +1 (614) 575-2600 • Email: [email protected] (for general, non-PHI questions only)

What is “balance billing” (sometimes called “surprise billing”)?

When you get care, you usually pay your plan’s in-network amounts (copay, coinsurance, and/or deductible). If you see an out-of-network provider or use an out-of-network facility, that provider or facility may charge you the difference between what your plan pays and their full charge. That difference is balance billing. It’s often higher than in-network costs and may not count toward your annual out-of-pocket maximum.

A surprise bill is an unexpected balance bill—commonly after emergency care or when, at an in-network facility, you’re unknowingly treated by an out-of-network provider (e.g., anesthesia, radiology, pathology).

You are protected from balance billing for:

1. Emergency services
   • If you have an emergency medical condition and get emergency care from an out-of-network provider or facility, the most you can be billed is your plan’s in-network cost-sharing (copays/coinsurance/deductibles). You can’t be balance billed for these emergency services. This includes post-stabilization services unless you give written consent to be billed out-of-network and waive your protections.
2. Certain services at in-network hospitals or ambulatory surgery centers
   • When you receive care at an in-network hospital/ASC, some clinicians involved in your care may be out-of-network. For certain specialties—emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, intensivist—those providers cannot balance bill you and may not ask you to waive protections.

For other services, out-of-network providers at in-network facilities may ask you to consent in writing to be billed out-of-network—but you are never required to agree. You can always choose in-network care.

When balance billing isn’t allowed, you also have these protections:

• You only pay your in-network share (copay/coinsurance/deductible). Your plan pays any additional out-of-network amounts directly to the provider/facility.
• Your plan must:
  • Cover emergency services without prior authorization.
  • Cover emergency services provided by out-of-network clinicians and facilities.
  • Base your cost-sharing on the amount it would pay in-network and show this in your Explanation of Benefits.
  • Count what you pay for emergency or protected out-of-network services toward your deductible and out-of-pocket limit.

If you think you’ve been wrongly billed

1. Contact the billing office listed on your statement to review the claim.
2. Contact MODDA Billing:
   Mid Ohio Digestive Diseases Associates (MODDA)
   99 Brice Rd N N, Columbus, OH 43213, USA
   Phone: +1 (614) 575-2600 • Email: [email protected] (no PHI)
3. Contact CMS (No Surprises Help Desk): 1-800-MEDICARE (1-800-633-4227) or visit cms.gov/nosurprises for your federal rights and complaint options.

Good Faith Estimate (for uninsured or self-pay patients)

You have the right to receive a Good Faith Estimate (GFE) explaining how much your medical care will cost.

• If you don’t have insurance or aren’t using insurance for a non-emergency service, ask for a written GFE for the total expected charges (tests, procedures, drugs, equipment, facility fees).
• You should receive your GFE at least 1 business day before your scheduled service. You can request a GFE before you schedule.
• If you receive a bill that is $400 or more above your GFE, you can dispute the bill.
• Keep a copy or photo of your GFE.

More information: Visit cms.gov/nosurprises or call 1-800-MEDICARE (1-800-633-4227).

How MODDA can help

• Questions about coverage or networks? Call us at +1 (614) 575-2600 with your insurance card handy.
• Online bill pay or financial policy: See billing for payment options and our financial policy.
• Referrals & hospital/ASC care: If your care is scheduled at a hospital or surgery center, we’ll explain which services are covered in-network and how No Surprises protections may apply.

This disclosure is provided in plain language to help you understand your rights under the No Surprises Act. It is not legal advice. For complete, current information, visit cms.gov/nosurprises.