No Surprises Act Provider Disclosure Notice

Premier NeuroSpine Institute, LLC (“PNI”) is committed to transparency in healthcare pricing. As required by the No Surprises Act, we are providing you with this notice to inform you of your rights and our responsibilities regarding potential surprise medical bills.

What Is the No Surprises Act?

The No Surprises Act is a federal law enacted in the United States as part of the Consolidated Appropriations Act, 2021. It aims to protect patients from unexpected and often exorbitant medical bills that arise when they inadvertently receive care from out-of-network providers, particularly when receiving care in emergency situations or at in-network facilities. The act establishes provisions for billing and dispute resolution, requiring healthcare providers and insurers to provide patients with clear and transparent information about their healthcare costs, coverage, and rights.

Out-of-Network Services

These are providers with which your health plan does not have a contract. Depending on your contract, that could be us. Your healthcare plan might pay us a lower amount than it would pay for the same service by an in-network provider. You are then responsible for a greater balance.

IN AN EMERGENCY, YOU MIGHT NOT BE ABLE TO CONTROL WHO PROVIDES YOUR CARE.

If you do not know if we are in-network or out-of-network, just ask our front desk.

Balance Billing

Balance Billing is sometimes also referred to as “Surprise Billing.” This type of billing occurs when you have no control over who provides your treatment.

  • Balance Billing includes billing by out-of-network providers for emergency services and certain non-emergency services performed at in-network facilities.
  • Protections against Balance Billing ensure that patients are only responsible for their in-network cost-sharing amounts.
  • Patients are protected from balance billing for emergency services, air ambulance services, and certain non-emergency services provided by out-of-network providers at in-network facilities.
  • Instead of being billed directly for the balance, patients are only responsible for their in-network cost-sharing amounts, such as copayments, coinsurance, and deductibles.

Your Rights

  • Emergency Services: When you receive emergency treatment from an out-of-network provider at an in-network facility, you will be billed at your plan’s in-network rate.
  • Advance Notice of Services: You have the right to receive a good faith estimate of expected charges for any non-emergency healthcare service.
  • Provider Network: You have the right to know whether the provider is in-network or out-of-network with your insurance plan.
  • Notice of Referrals: You have the right to be informed if any services or providers involved in your care are out-of-network and to request in-network alternatives if available.
  • Consent for Out-of-Network Services: You have the right to provide written consent before receiving non-emergency out-of-network services, acknowledging your understanding of potential financial responsibility.
  • Dispute Resolution: You have the right to dispute surprise medical bills through an independent resolution process.
  • Protection from Balance Billing: You are protected from balance billing for emergency services, air ambulance services, and certain non-emergency services provided by out-of-network providers at in-network facilities. You are never required to give up 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.

Provider Responsibilities

  • Accurate Billing: We are responsible for accurately estimating and disclosing the cost of services, including any out-of-pocket expenses.
  • Notification of Network Status: We will inform you if we are in-network or out-of-network with your insurance plan before providing non-emergency services.
  • Referral Notification: If a referral is necessary for your care, we will notify you if any referred services or providers are out-of-network and provide in-network alternatives if available.
  • Obtaining Consent: Before providing non-emergency out-of-network services, we will obtain your written consent, clearly explaining the potential financial implications.
  • Billing Transparency: We will provide transparent billing practices, including itemized bills detailing services rendered and associated costs.
  • Cooperation with Dispute Resolution: In the event of a dispute regarding a surprise medical bill, we will cooperate with the independent dispute resolution process and provide any necessary documentation or information.

Your Responsibilities

  • Insurance Information: You must provide accurate insurance information to facilitate accurate billing and coordination of benefits.
  • Advance Payment: For non-emergency treatment, you may be required to make advance payments for services not covered by insurance or for amounts exceeding the estimated cost.
  • Notice of Changes: You must promptly notify us of any changes to your insurance coverage or personal information that may affect billing or reimbursement.
  • Payment Obligation: You are responsible for any applicable copayments, coinsurance, deductibles, or charges not covered by your insurance plan.

Contact Information

If you have questions about your rights and responsibilities under the No Surprises Act, please contact our Billing Department or Compliance Department at 727-605-1770 or email Jimmany@pni.health.

For More Information

For more information about the No Surprises Act and your rights as a patient, please visit the CMS website: Ending Surprise Medical Bills. You may also contact CMS for information or to lodge a complaint at: 800-985-3059.