Legal Notifications for Clients

Your Rights and Protections Against Surprise Medical Bills

(OMB Control Number: 0938-1401) 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, including services you may get after you're in stable condition — unless you give written consent and give up your protections against being balance 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.

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.

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 deductibles you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must cover emergency services without requiring prior authorization.
• Your health plan generally must cover emergency services by out-of-network providers.
• Your health plan generally must base what you owe (cost-sharing) on what it would pay an in-network provider or facility, and show that amount in your explanation of benefits.
• Your health plan generally must count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you've been wrongly billed, you may contact the Idaho Department of Insurance Consumer Affairs team at 208-334-4319.

Visit cms.gov for more information about your rights under federal law, or the Idaho Department of Insurance for your rights under Idaho law.

Standard Notice: "Right to Receive a Good Faith Estimate of Expected Charges" Under the No Surprises Act

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.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services, including related costs like medical tests, prescription drugs, equipment, and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, or 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.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call Paradise Creek Counseling and Consulting at (208) 882-2566.

Notice of Privacy Practices (Brief Version)

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our commitment to your privacy

Our practice is dedicated to maintaining the privacy of your personal health information as part of providing professional care. We are also required by law to keep your information private. These laws are complicated, but we must give you this important information. Please talk to your counselor about any questions or problems.

How we use and disclose your protected health information with your consent

We will use the information we collect about you mainly to provide you with treatment, to arrange payment for our services, and for some other business activities that the law calls "health care operations." After you've read this notice, we will ask you to sign a consent form to let us use and share your information in these ways. If you do not consent and sign this form, we cannot treat you. If we want to use, send, share, or release your information for other purposes, we will discuss this with you and ask you to sign an authorization form.

Disclosing your health information without your consent

There are some times when the law requires us to use or share your information. For example:

• When there is a serious threat to your or another's health and safety, or to the public. We will only share information with persons able to help prevent or reduce the threat.
• When we are required to do so by lawsuits and other legal or court proceedings.
• Situations involving abuse or neglect of a minor or dependent adult.
• For workers' compensation and similar benefit programs.

There are some other, rarer situations, described in the longer version of our Notice of Privacy Practices.

Your rights regarding your health information

1. You can ask us to communicate with you in a particular way or at a certain place that is more private for you — for example, calling you at home and not at work to schedule or cancel an appointment. We will try our best to do as you ask.
2. You can ask us to limit what we tell people involved in your care or the payment for your care, such as family members and friends.
3. You have the right to look at the health information we have about you, such as your medical and billing records, and to get a copy of these records.
4. If you believe the information in your records is incorrect or missing something important, you can ask us to make additions to correct it. This request must be in writing, and you must tell us the reasons you want the changes made.
5. You have the right to a copy of this notice. If we change this notice, we will post the new version in our waiting area, and you can always get a copy from the front office.
6. You have the right to file a complaint if you believe your privacy rights have been violated — with our privacy officer, and with the Secretary of the U.S. Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care we provide to you in any way.

You may also have other rights granted by the laws of our state, which may be the same as or different from the rights described above. We're happy to discuss these situations with you now or as they arise. If you have questions about this notice or our health information privacy policies, please talk to your therapist or refer to our grievance policy posted in the waiting area.