Rights & Protections Against Surprise Med. Bills in Novato CA
When you get emergency care in Novato CA or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance and/or deductible.
What is "balance billing" (sometimes called "surprise billing") in Novato CA?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional 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" means providers and facilities that haven't signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 plan's deductible or 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 innetwork 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're never required to give up your protections from balance billing. You also aren't required to get out-of-network care. You can choose a provider or facility in your plan's network.
When balance billing isn't allowed, you also have these protections:
You're only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible 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, contact the HHS via the federal phone number for information and complaints: 1 (800) 985-3059.
Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
We are very sensitive to health care costs and offer payment options. Cost may vary between ranges depending your insurance plan, on complexity of your condition, time spent, services received, and if payment same day discount applies.
We offer no charge insurance verification, but all patients must be aware that they are ultimately responsible for verifying their own insurance coverage. This office cannot be liable for misinformation provided by an insurance carrier.
Each treatment involves a chiropractic adjustment and manual therapy.
Physiotherapy and exercise if commonly provided as well.
All services are reviewed with patients prior to beginning care to get consent.
Exam fees are charged for new patients, established patients with new injuries or complaints, and established patients who have not been seen in over 90 days.
The total number of treatments is subject to each patient's diagnosis or condition specifically and how the body responds to treatment.
Before seeing any of our chiropractor, if we are not in network with your insurance provider, or you opt not to use your insurance or if you do not have insurance, these costs will be explained to you, and per the "No Surprises Act" you will be asked to sign a paper stating that you agree to pay the cost of treatment as outlined above at the time of each visit.
Here, at DeSalvo Chiropractic, we aim to get the results you are looking for in as few visits as possible, with out any billing surprises.
8:30am - 6:00pm
1:30pm - 6:00pm
8:30am - 6:00pm
8:30am - 6:00pm
8:30am - 11:30pm
Saturday & Sunday