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YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE  MEDICAL BILLS

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

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

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs,     such as a copayment, coinsurance, and/or a deductible. You may have other 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” describes providers and facilities that haven’t signed a contract with your health plan. 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 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 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 in-network facility but are unexpectedly treated by an out-of-network provider.

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). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable  condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

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

When you get services from an in-network hospital or ambulatory surgical center, certain 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, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections  not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.

You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

Surprise Billing in Illinois

Illinois state law (Illinois Public Act 096-1523) protects you from “balance” or “surprise” bills when you receive care at an in-network facility or ambulatory surgery center from out-of-network providers who provide radiology, anesthesiology, pathology, neonatology, or emergency physician services at that in-network facility.

In these situations, you cannot be charged greater out-of-pocket expenses than you would have been for covered, in-network physician or provider services. The out-of-network provider should not send you a bill.

Exceptions to Illinois Surprise Billing Protections

You could, however, still be required to pay an out-of-network bill in certain situations. Illinois’ surprise billing protections only apply to insurance plans regulated by the state of Illinois. Therefore, if your insurance plan is not regulated by the state, you may still be billed for these out-of-network charges. Further, these protections only apply to certain out-of-network providers who are based in an in-network facility; if the facility where you receive these services itself is out-of-network, you can also receive an out-of-network bill. Similarly, these protections do not apply if you purposely choose a provider not within your insurance network.

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

  • You are only responsible for paying your share of the cost (like 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
  • Your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • Cover emergency services by out-of-network
  • 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
  • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket

If you believe you’ve been wrongly billed, you may contact:

The Illinois Department of Insurance
320 West Washington Street Springfield, IL 62767
1-877-527-9431

Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.

(OMB Control Number: 0938-1401)

Call (630) 423-5935 for more information or to set up an appointment.

Life Care Wellness | 800 Roosevelt Rd, Building C, Suite 206, Glen Ellyn, Illinois
Serving West Chicagoland including Winfield, Wheaton, Lisle, Glen Ellyn, Lombard, Downers Grove and Elmhurst.

Life Care Wellness | 5408 N. Long Avenue, Chicago, Illinios
Serving Jefferson Park, Lincolnwood, Edgebrook, North Park, Albany Park, Harwood Heights, Norwood Park and the near North suburbs including Park Ridge, Niles, Skokie and Evanston.

Life Care Wellness | 1958 Aberdeen Ct, Sycamore, Illinois
Serving DeKalb and Northern Illinois University area along with Cortland, Genoa, Maple Park, Kingston, Burlington, Hampshire, Malta, Kirkland, and Elburn.

Our Glen Ellyn Office Has Moved!

To serve you better with even more space, we have moved to a new building just a few blocks away. Our new Glen Ellyn location in the Glen Hill North office park is:

800 Roosevelt, Bldg C, Suite 206

Glen Ellyn, IL 60137

 

COVID Safety Update

All Life Care Wellness facilities are currently operating with added safety precautions. We also continue to provide telehealth opportunities for those who prefer to remain in the comfort of their own home.

Our Specialties

  • Trauma & Grief Counseling
  • Addiction Counseling
  • Anxiety & Depression Counseling
  • EMDR Therapy
  • Somatic Experiencing
  • Yoga Therapy
  • Group Therapy
  • Therapy for Co-Occurring Disorders
  • Pharmacotherapy

Services

  • Individual Therapy
  • Group Therapy
  • Couples Counseling
  • Family Therapy
  • Child & Adolescent Therapy
  • Mediation
  • Case Consultation
  • Life & Executive Coaching
  • Wellness Education
  • Speaking & Educational Programs

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Life Care Wellness
800 Roosevelt, Bldg C, Suite 206
Glen Ellyn, IL 60137
Second Location:
5408 N. Long Ave, Chicago, IL 60630
Third Location:
1958 Aberdeen Ct, Sycamore, IL 60178

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