Your Rights and Protections Against Surprise Medical Bills
Winchester OB/GYN Associates, P.C.
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:
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.
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: https://www.mass.gov/service-details/submit-a-complaint-against-a-physician
Visit https://www.cms.gov/nosurprises for more information about your rights under federal law. Visit https://www.mass.gov/news/pricing-transparency-provisions-of-an-act-promoting-a-resilient-health-care-system-that-puts-patients-first-patients-first for more information about your rights under state laws.
Loved Dr. Druga for my prenantal care. Delivered both of my children many years ago. Has been by GYN for many years thereafter. He's a good listener with excellent bedside manner and does not rush through my appointments. I've been to him as well as NPs in the practice through the years - all excellent.
I was a patient of doctor Bose for my first pregnancy. I have seen reviews mentioning long "wait times". I did not personally experience that with Dr. Bose but I would consider her to be worth the wait. I would go to my OB appointments on my lunch break and never had an issue returning to work on time. I worked for Winchester Hospital for over 5 years and chose her to be my doctor for prenatal care because she has a reputation among hospital staff for being one of the best.
I also had the most pleasant encounter with Dr. Druga on an unexpected visit to L&D. His bed side manner left a lasting impression. He was very kind and and had excellent eye contact. Bottom line is that I would highly recommend this office.
Dr Bose and her advanced practitioners did a wonderful job with my prenatal care. They were thorough, courteous and evidenced-based in their care. The front desk staff were especially accommodating and helpful. They went out of their way to help me with scheduling ultrasounds and other testing with my rather difficult schedule. I saw Dr. Druga once in Dr. Bose’s absence and I was very happy with him as well. Dr. Bose attended my induction and delivery despite not being on call and stayed into the night until my daughter was born. I completely believe that she helped me avoid a c-section. The staff and Dr. Bose were also great in follow up and were most expeditious in helping me arrange my IUD placement. (Which, for the record went very well as well). Would absolutely return to the practice for further obstetric needs.
Over 40 weeks in 2021, I was a patient — mainly assisted/seen by Pat, HaiDang, and Dr Bose -- and I just want to say that I received the very best of care here. From week 5 of pregnancy, they set me up with answers to my first-time-mommy questions, ultrasounds, nearby bloodwork, everything. I also utilized the answering service on a couple late nights (including when I, correctly, thought I was in labor) and always got a quick callback w everything I needed. Dr Bose delivered my baby at Winchester Hospital less than 24 hours after my 40 week appt, so I feel very lucky and grateful to this team of amazing women who saw me all the way through my first full-term pregnancy! For nearly a year of my life, I looked forward to visiting this practice for my pregnancy appts here and definitely recommend. 5/5
Dr. Druga is amazing!!! He made me so comfortable throughout the whole process. I look forward to him delivering my future children.
Dr Bose and her advanced practitioners did a wonderful job with my prenatal care. They were thorough, (courteous and evidenced-based in their care. The front desk staff were especially accommodating and helpful. They went out of their way to help me with scheduling ultrasounds and other testing with my rather difficult schedule. I saw Dr. Druga once in Dr. Bose's absence and I was very happy with him as well. Dr. Bose attended my induction and delivery despite not being on call and stayed into the night until my daughter was born. I completely believe that she helped me avoid a c-section. The staff and Dr. Bose were also great in followup and were most expeditious in helping me arrange my IUD placement. (Which, for the record went very well as well). Would absolutely return to the practice for further obstetric needs.
I have been going there since 2017 for all of my pregnancies and wouldn't dream of going anywhere else. The doctors are as good as it gets and have compassionately navigated me through some pretty complicated pregnancy issues. I personally work with Dr. Bose but have also seen Dr. Druga and both are excellent. I couldn't recommend them more.
Dear Dr. Bose, Thank you so much for everything you have done for me and my family! We are so grateful to you and your staff! Thank you again!
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