SURPRISE BILLING

No Surprise Bills at Nashville Healthcare Diagnostic Imaging

Our practice does not surprise-bill patients. Federal and Tennessee state law protect you from unexpected out-of-network charges, and we work to make sure you understand your financial responsibility before your visit. If you ever receive a bill you believe is in error, contact us right away at (615) 341-4517 or billingquestions@nashvilleha.org.

Your Rights and Protections Against Surprise Medical Bills

You are protected from surprise billing or balance billing. You're never required to give up your protections from balance billing or to receive care out of network. You can always choose a provider or facility in your plan's network.

Federal protections apply when you get emergency care, or when you schedule a visit at an in-network hospital or ambulatory surgical center but are unexpectedly treated by an out-of-network provider.

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

"Surprise billing" is an unexpected balance bill. This can happen when you can't control who is involved in your care. When you see a doctor or health care provider, you may owe certain out-of-pocket costs — such as a copayment, coinsurance, or a deductible. If the provider is out-of-network with your health plan, you may have to pay a higher cost, up to the full amount charged for the service. 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. This is called "balance billing." It is likely more than in-network costs for the same service, and it might not count toward your annual out-of-pocket limit.

You are Protected from balance billing for:

Emergency Services: 

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan's in-network cost-sharing amount (such as copayments and coinsurance). Unless you give written consent to give up your protections, you cannot be balance-billed for these emergency services. This includes services you may receive after you are in stable condition.

Certain services at an in-network hospital/ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, some providers there may be out-of-network. In these cases, the most those providers may bill you is your 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 may not ask you to give up your protections.

If balance billing isn’t allowed, you are still Protected!

You are only responsible for paying your share of the cost (the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

Your health plan generally must:

• Cover emergency services without requiring you to get approval in advance (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, and show that amount in your explanation of benefits
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit

If you believe you’ve been wrongly billed, you may contact compliance@nashvilleha.org

Visit https://www.cms.gov/nosurprises for more information about your rights under federallaw. Visit Tennessee Senate Bill 2640 for more information about your rights under TN state law.