Transparency in Coverage

Atrium Medical Center is partnered with Centers for Medicare & Medicaid Services (CMS) and receives accreditation from the Center for Improvement in Healthcare Quality (CIHQ). Because of our partnership, Atrium Medical Center is mandated by federal law (as per The Consolidated Appropriations Act of 2021 and the No Surprises Act within) to inform you of your rights and protections against surprise medical bills, sometimes referred to as “balance billing.”

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way unless specifically incorporated into a contract. This document is intended only to provide clarity to the public regarding existing requirements under the law.

For more information, visit https://www.cms.gov/nosurprises#.

Health care providers are contracted with insurance companies to provide in-network services to customers who pay for the health care insurance. When people visit in-network providers, they can expect to be charged for out-of-pocket costs such as co-payment, co-insurance and/or a deductible. Not all the services that a health provider offers are encapsulated by the insurance company they are contracted with, and so in the past, it has been the case that customers received “out-of-network” services from a health care provider that was not covered by their insurance. This leaves the patient footing the difference between the charges the provider billed and the amount paid by the consumer’s health plan. This is what is known as “balance billing”.

This also occurs when you can not control which provider you see for health care services–commonly seen when one experiences an emergency, necessitating a visit to an out-of-network provider. Balance billing is likely to cost more than in-network expenditures for similar services and may not go towards the annual out-of-pocket limit with your insurance provider.

Starting January 1st, 2022, you are now protected from surprise billing from emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Your insurance plan will pay out-of-network providers and facilities directly, and you are responsible for the cost-sharing amount of your insurance the same as with an in-network provider.

• Emergency Services

• If you experience a medical emergency and have go out-of-network to receive treatment, the most you will have to pay is your healthcare insurance plan’s cost-sharing amount (co-payment, co-insurance, etc). By federal law, you can not be balance billed for the treatment, even for the post-stabilization services. You will not need approval from your insurance provider to receive coverage for out-of-network emergency services (this is known as “prior authorization”). You can only be balance billed if you willingly give up your protections and the hospital may not ask if you wish to do so.

• Out-of-Network Services in In-Network Hospitals

• If you receive out-of-network services from an in-network facility, you are protected from balance billing. As with emergency services, the most you will need to pay is the cost-sharing amount required by your insurance company. You can only be balance billed if you willing relinquish your protections and the hospital is not allowed to ask if you would like to do so.