Your Rights and Protections

Against Surprise Medical Bills

 

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 copayments, 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 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’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.

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

• You’re 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’ve been wrongly billed, contact the No Surprises Helpdesk at 1-800-985-3059.

Visit www.cms.gov/nosurprises for more information

 

Patient Pricing Information

please call for details

 

You have reached the federally-required section of our website that contains the charges for the services we provide within our facility. While we provide this information to comply with federal regulations, healthcare billing is complex. It is extremely important for you, as the consumer, to understand that standard charges may not be a relevant starting point for estimating what costs you may incur during an episode of care, and the amount actually paid by a patient will depend on that patient’s insurance coverage, policy provisions and other factors. Everyone’s case is different based on that patient’s medical condition. 

Please contact OLSH Patient Billing directly for more information regarding your specific financial responsibility at 715.858.3726.

 

IMPORTANT INFORMATION REGARDING PRICE ESTIMATOR TOOL USE
Here is how our price estimate tools and resources work:

• For insured patients: Your real-time insurance benefits are applied to expected costs to determine the amount you are responsible for paying after insurance.
• For uninsured patients: Your out-of-pocket costs are based on a discount for the amount generally billed for hospital services.

Why costs may vary:
Many things affect the cost of health care services. For example, the price of a CT scan (used to obtain images of soft tissue and blood vessels) depends on what part of the body is being scanned and whether a contrast agent (special dye) is needed to make the organs and tissue more visible.
The cost estimates provided by our tool may be different from your actual costs for several reasons, including but not limited to:

• The medical services/treatment you receive will be based on decisions made by you or your health care provider and may be different from the services you selected while using the price estimator tool. 
• The medical service/treatment you receive may be impacted by complications, secondary conditions, and/or other unknown factors that this price estimator tool cannot consider.
• The location of where your services are received differs from what is selected during this estimation process.
• If your year-to-date benefit information changes from the time at which you receive this estimate and the time at which you receive care.
• If your healthcare provider’s contract with your insurance carrier changes.
• If you have a unique insurance plan design that is not currently supported by the tool.

For more information on how your cost estimate was determined, please contact 715.858.3726.
In addition to using our Cost Estimator Service, your insurance carrier can help you understand insurance terms such as out-of-pocket maximums, deductibles and copayments that will affect what you ultimately pay. Patients enrolled in Medicare can find insurance information at www.Medicare.gov.
Before using this cost estimation tool, please carefully consider the following information:

• By clicking on the estimator tool, you are acknowledging that you have read the information above, and that you are accessing this information for the purpose of determining your estimated costs associated with healthcare services.
• Nothing on this site guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. For a complete description of the details of your coverage, please refer to your coverage information from your healthcare insurance carrier.
• Please keep in mind, the costs provided in this tool are estimates only and are not a guarantee of payment or benefits. Again, the estimates are based on the contract rates/fee schedule with your insurance carrier. Your actual cost may be higher or lower than the estimate for various reasons. You will be responsible for the cost of procedures or services not covered by your insurance plan.

Click below for an online estimator tool:
Patient Price Estimator Tool

You can view the OakLeaf Surgical Hospital price list by clicking the following link:
OakLeaf Surgical Hospital Charge Data for Price Transparency