Surprise Billing Protections

PARAGON WOUND CARE

Surprise Bill Protection Statement

At Paragon Wound Care, we are committed to providing transparent and fair billing practices to our patients. We understand that unexpected medical bills can be a significant source of stress and financial burden. To ensure our patients are protected from surprise billing, we have implemented the following measures:

1. Transparency in Billing We provide clear and detailed information about the costs associated with your care. Before any procedure or treatment, you will receive an estimate of the charges, including any potential out-of-pocket expenses.
2. Good Faith Estimate
   a. You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
   b. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
3. No Surprise Billing If you receive emergency care or are treated by an out-of-network provider at an in-network facility, you will not be billed more than the in-network rate for those services. We adhere to federal and state regulations to protect you from surprise medical bills.
4. Patient Support Our billing department is available to assist you with any questions or concerns you may have about your bill. We are committed to helping you understand your charges and resolving any billing issues promptly.
5. In-Network Assurance We make every effort to ensure that our services are provided by in-network providers. If you receive care from an out-of-network provider at one of our facilities, we will work with you to minimize any additional costs.

At Paragon Wound Care, your health and peace of mind are our top priorities. We are dedicated to providing high-quality care without the worry of unexpected medical bills.

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

You’re 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 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 are in stable condition, unless you give written consent and give up your protections not to be balance billed for these post-stabilization services.
• In addition to federal law, the state of Florida prohibits balance billing for emergency services for those individuals covered by PPO and HMO health plans licensed in the state of Florida*.

Insured persons enrolled in HMO or PPO health plans are not liable for out-of-network emergency services, except for applicable copayments, coinsurance, and deductibles.

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
• Intensivist services

These providers cannot 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.

The state of Florida also prohibits all balance billing of members covered by Florida licensed HMOs, including in non-emergency settings. Per Florida law, insured persons enrolled in a PPO may not be balanced billed for non-emergency services if the insured person is at an in-network facility but does not have the ability or opportunity to choose a participating provider.

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

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
• Generally, your health plan must:
  • Cover emergency services without requiring you to get approval for services in advance (also known as “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 or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you have been wrongly billed, contact:

Federal: 1-800-985-3059 or www.cms.gov/nosurprises/consumers
State: 1-877-693-5236 or 850-413-3089 or Consumer.Services@myfloridacfo.com

Good Faith Estimate – Know Your Rights

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.
• You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

Please contact our Business Office to obtain a Good Faith Cost Estimate at 904-345-7600.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-MEDICARE (1-800-633-4227).