Resources

Patient Resources.

Thank you for selecting Scott Orthopedic Center for your orthopedic care. To schedule an appointment, please call us at (304) 525-6905 Opt #1 OR #0. PLEASE NOTE THAT IT TAKES 24-48 HOURS TO REACH OUR OFFICE!

Balance Billing Information

Your Rights and Protections Against Surprise Medical Bills

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. 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.

Additionally, West Virginia law protects patients by limiting patients’ payments for out-of-network emergency services to their in-network cost sharing amounts. This law applies to patients with coverage through health maintenance organizations, health care corporations, individual accident and sickness insurers, group accident and sickness insurers, hospital service corporations, medical service corporations, dental service corporations, and health service corporations.

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 not to be balance billed.

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 protections 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 the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that 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 you to get approval for services in advance (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 deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact:

• The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit https://www.cms.gov/nosurprises for more information about your rights under federal law.
• Your health plan to ask them why you got the bill and if it’s correct. If it was an emergency, ask your health plan if they processed your claim as an emergency.
• The West Virginia Offices of the Insurance Commissioner at https://www.wvinsurance.gov/Consumer_Services or by phone at 1-888-TRY WVIC (888-879-9842) or (304) 558-3386.

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, healthcare 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. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.
• Make sure your healthcare 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 healthcare 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.

Financial Assistance Policy

Scott Orthopedic, an outpatient facility of St. Mary's Medical Center is committed to ensuring that uninsured patients and underinsured patients meeting medical hardship criteria within the communities we serve who lack financial resources have access to emergency and medically necessary hospital services.

St. Mary’s Medical Center and its staff will:

• Treat all patients equitably, with dignity, respect, and compassion;
• Serve the emergency health care needs of everyone who presents to our facilities, regardless of a patient's ability to pay for care;
• Assist those patients who are admitted through our admission process for non-urgent, medically necessary care who cannot pay for the care they receive; and
• Balance needed financial assistance for some patients with broader fiscal responsibilities to keep its hospitals' doors open for all who may need care in the community.

In meeting its commitments, St. Mary’s Medical Center will work with those seeking emergency and medically necessary care to better understand each patient’s financial resources.

Financial counselors are on hand to address your concerns. Their offices are located on the main floor near the main lobby registration area. They are available Monday through Friday, 8 a.m. to 4:30 p.m. or may be reached by phone at 304.526.1539.

Learn more about our Financial Assistance Policy.

Financial Assistance Verification Form - Financial-Assistance-Income-Verificaton-Form

Financial Assistance Application - Financial-Assistance-Application

2023 Federal Poverty Guidelines - 2023-Poverty-Guidelines-_SMMC-FAP

Appendix B - Financial Assistance Policy Plain Language Summary  - Appendix-B-Plain-Language-Summary-Financial-Assistance-Policy

Appendix C - Provider List  - St.-Marys-Medical-Center-Provider-List-for-Financial-Assistance-Policy

Get More Information

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