Surgical Assistants of San Antonio

SASA Disclosure Notice Regarding CMS Patient Protections Against Private Billing 

Section 2799B-3 of the Public Health Service Act (PHS Act) requires health care providers and facilities to make publicly available, post on a public website of the provider or facility (if applicable), and provide a one-page notice that includes the following information in clear and understandable language: 

• The federal restrictions on providers and facilities regarding balance billing in certain circumstances

• Any applicable state law protections against balance billing.

• Information on contacting appropriate state and federal agencies if an individual believes a provider or facility has     violated the restrictions against balance billing.

Public disclosure requirements:

• The disclosure notice must be publicly available, posted on the searchable homepage of SASA's website: www.surgicalassistsa.com.

• To meet the public disclosure requirement, providers and facilities must prominently display a sign with the required disclosure unless the provider doesn't have a publicly accessible location.

Who should get this notice: 

• Participants, beneficiaries, or enrollees of a group health plan or group or individual health insurance coverage offered by a health insurance issuer, including covered individuals in a health benefits plan under the Federal Employees Health Benefits Program.

• Whom the provider or facility furnishes items or services, but only if such items or services are furnished at a health care facility, or in connection with a visit at a health care facility.

• SASA provides these documents to all individuals including Medicare, Medicaid, or to any individual who is uninsured. However, out-of-network billing does not apply to Medicare, Medicaid, Tricare or Workers' Comp.

The Patient Billing Notice was provided in the surgical packet as a single page, 12pt or larger font. Providers and facilities must issue the Billing Disclosure notice no later than the date and time they request payment from the individual. If the provider or facility does request payment from the individual, they must provide the notice no later than the date they submit a claim for payment to the plan or issuer. 

Language access and use of plain language: Compliance with Federal Civil Rights Laws: Entities that get federal financial assistance must comply with federal civil rights laws that prohibit discrimination. These laws include section 1557 of the Affordable Care Act, Title VI of the Civil Rights Act of 1964, and section 504 of the Rehabilitation Act of 1973. Section 1557 and Title VI require covered entities to take reasonable steps to ensure meaningful access to individuals with limited English proficiency. Sections 1557 and 504 require covered entities to take appropriate steps to ensure effective communication with individuals with disabilities, Providers and facilities are reminded that the disclosure notice must comply with applicable state or federal language-access standards. Health care providers and facilities are encouraged to use plain language in the disclosure notice. Plain language, accessibility, and language access resources: 

• Plainlanguage.gov/guidelines 
• Section508.gov 
• LEP.gov 

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.

When you get emergency care 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 co payments, coinsurance and/or deductible. 

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, 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 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service. 

You're protected from balance and 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 they can bill you is your plan's in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). 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 can 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 types of 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 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.