SONOMA COUNTY INDIAN HEALTH PROJECT, INC.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in­network 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.

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. ff 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 co payments, 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 in­network 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 California Department of Managed Health Care 1-888-466-2219 for enforcement issues related to state regulated plans or 1-800-985-3059 (https://www.cms.gov/nosurprises/consumers ) for enforcement issues related to federally regulated plans. Visit http://www.cms.gov/nosurprises for more information about your rights under federal law. Visit http://www.healthhelp.ca.gov/ for more information about your rights under state law.

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Sonoma County Indian Health Project, Inc.

Sonoma County Indian Health Project, Inc.

Sonoma County Indian Health Project, Inc.

UPDATE: We are all out of veggies! See you next month 🥗👍 ... See MoreSee Less

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I always miss out on the goodies boooo

What’s the location

Thank you SCIHP crew!! Love you 💕🥰

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Family Fun Night
Dinner - Raffles - Games - Activities
April 7th from 5PM-7PM @ Gualala Arts Center
46501 Old Stage Road, Gualala
Contact [email protected] or Carolyn (707) 521-4559 for more information
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Enjou our SCIHP E-Newsletter for the month of March! If you are interested in applying to any of our current job listings, please follow this link: www.paycomonline.net/v4/ats/web.php/jobs?clientkey=0283999B7715AC744DC74C710392B283 ... See MoreSee Less

March 2023 Drive-Up Veggie Day
Santa Rosa: March 16th 11am-3pm
*LOCATION* 3771 Cleveland Ave (Previously Kmart Parking Lot)
MPA: March 17th 10am-12pm (MPA Satellite Clinic)
Kashia: March 17th 1pm-3pm (Kashia Community Center)
WHILE SUPPLIES LAST
Participants must wear a mask and remain in vehicle.
... See MoreSee Less

March 2023 Drive-Up Veggie Day
Santa Rosa: March 16th 11am-3pm 
*LOCATION* 3771 Cleveland Ave (Previously Kmart Parking Lot)
MPA: March 17th 10am-12pm (MPA Satellite Clinic)
Kashia: March 17th 1pm-3pm (Kashia Community Center)
WHILE SUPPLIES LAST
Participants must wear a mask and remain in vehicle.

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Thank you ❤️❤️❤️. First time for my family receiving our boxes, everything is so perfect and beautiful!

Native Youth Talking Circle for Ages 12-24
Every 1st & 3rd Monday
6PM-7PM on Zoom
To Sign Up Please Contact [email protected] or (707) 521-4559
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