No Surprise Act Patient Notice

• Under the federally mandated No Surprises Act and Oregon law, when you receive emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgery center, you are protected from surprise billing (also called balance billing).
• When you receive services from an in-network hospital or ambulatory surgery center, certain providers may be out-of-network. In these cases, the most these providers may bill you is your health plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, and intensivist services. These providers cannot balance bill you and cannot force you to sign a consent and give up your protections.
• Other out-of-network providers operating at an in-network health care facility who provide non-emergency services to insured patients cannot bill you an amount greater than your health plan’s in-network cost-sharing amount unless the provider has obtained written consent from you. Consent is voluntary-you are never required to consent and give up your protections, and you are not required to receive care out of network.
• Oregon law protections do not apply to non-emergency services when you choose to receive services from an out-of-network provider.
• When balance billing isn’t allowed, you are only responsible for paying your share of the costs that you would pay if the provider or facility was in-network. Your health plan will pay out of network providers/facilities directly. Your health plan generally must:
  • Cover emergency services without requiring you to get prior authorization for emergency services by out-of-network providers.

Base what you owe the provider/facility (cost-sharing) on what it would pay an in-network provider/facility and show that amount in your explanation of benefits (EOB).

• • Count any amount you pay for emergency services toward your deductible and out-of-pocket limit. If you believe you’ve been wrongly billed, please visit: https://www.cms.gov.nosurprises/consumers or call 1-800-985-3059. You may also contact the Oregon Division of Financial Regulation at 888-877-4894 or file a complaint by visiting: https://dfr.oregon.gov/help/complaints-licenses/pages/file-complaint.aspx

Your Right to Receive a Good Faith Estimate of Expected Charges

Your Rights and Protections Against Surprise Medical Bills Part II Your Right to Receive a Good Faith Estimate of Expected Charges Under the federally mandated No Surprises Act and Oregon law, if you do not have healthcare insurance, or if you will not be using your insurance, you have the right to receive a “Good Faith Estimate” of the total expected cost of non-emergency medical services.

• You have the right to receive a “Good Faith Estimate” for the total expected cost of any non-emergency medical services reasonably expected to be furnished for your medical service, and for medical services reasonably expected to be furnished in conjunction with your medical service.
• You should be given 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 from our office that is at least $400 more than your Good Faith Estimate, you may dispute the bill by contacting the billing office at 541-776-7622. If you are not able to resolve the dispute with our billing office, you may choose to start a dispute resolution process by visiting: https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059. Dispute claims must be filed within 120 days of the date on your bill.

Note: No Surprises Act does not apply to beneficiaries or enrollees in federal programs such as Medicare, Medicaid, Veterans Administration, Indian Healthcare Services or TRICARE. These programs have other protections against surprise medical bills.