Medical insurance information:
Susquehanna Retina Center participates with most insurances and will submit claims to the medical insurance on behalf of the patients seen in the practice. Office visit charges are expected at the time of service. Feel free to call our office prior to your visit to have your questions answered or to verify that we participate with your insurance.
The insurances we participate with include:
Medicare
Highmark
Capital Blue
Aetna
Humana
UHC
Tricare
Cigna
Multiplan
UPMC
Geisinger
Highmark Wholecare (formerly Gateway)
Amerihealth Caritas
Health Partners
Mail Handlers Benefits Plan (MHBP)
Health Net Federal (Veteran’s Choice Program and Champ VA)
Notice of Patient Rights and Protections Against Surprise Medical Bills
Beginning January 1, 2022, healthcare facilities must provide a good faith estimate of expected charges to uninsured patients, or to insured patients if the patient does not plan to have their health plan help cover the costs (self-paying individuals). The good-faith estimate must be provided after a patient has scheduled a surgery, or upon their request. It should include expected charges for the primary item or service they’re getting, and any other items or services that are provided as part of the same scheduled experience.
“Surprise billing” is an unexpected balance bill. “Out-of-network” describes a facility that has not signed a contract with your health plan. If you have an emergency medical condition and get emergency services, the most the facility may bill to you is the in-network cost-sharing amount
As the patient, you have the following protections:
You are 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 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.
If you believe you’ve been wrongly billed, you may contact www.cms.gov/nosurprises for more information about your rights under federal law.
Nota de Derechos y Protección del Paciente Contra Cuentas Médicas Sorpresa
Empezando el 1ro de enero del 2022, centros médicos deben proveer un estimado de buena fe de cobros que se le van a hacer a consumidores sin seguro, o a consumidores asegurados cuando el paciente no planea que su plan de seguro no le ayude a cubrir costos (individuos que pagan por cuenta propia). El estimado de buena fe tiene que ser proveído después de que un paciente ha programado una cirugía, a si lo solicita. Debería incluir cargos esperados por artículo principal o servicio que se les está dando, y cualquier otro artículo o servicio que sea proveído como parte de lo que ha programado.
“Facturación sorpresa” es una cuenta inesperada con balance. “Fuera-De-Red” describe un centro que no ha firmado un contrato con su plan de salud. Si usted tiene una condición médica de emergencia y obtiene servicios de emergencia, lo más que el centro le puede cobrar es el costo compartido “En-Red”.
Como paciente, usted tiene las siguientes protecciones:
Usted es responsable por pagar su parte del costo (Como copagos, coaseguranza y deducibles que usted pagaría si el proveedor o centro estuvieran “En-Red”.
Su plan de salud generalmente debe:
Cubrir servicios de emergencia sin requerir que usted obtenga aprobación por servicios por avanzado (Autorización previa).
Cubrir servicios de emergencia por proveedores “Fuera-De-Red”.
Basar lo que usted debe al proveedor o centro (costo compartido) en cuanto el plan pagaría a un proveedor o centro “En-Red” y mostrar ese monto en su explicación de beneficios.
Si usted cree que le han cobrado erróneamente, usted puede contactar www.cms.gov/nosurprises para mayor información acerca de sus derechos bajo ley federal.