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.

CLINIC CLOSURE in Observation of American Indian Day
Friday, September 22nd, 2023
For an emergency please call 911
In case of an urgent Medical issue, please call 707-521-4500
For an urgent Behavioral Health issue, please call 707-521-4550
*Please remember to order and pick up your prescription(s).
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CLINIC CLOSURE in Observation of American Indian Day
Friday, September 22nd, 2023
For an emergency please call 911
In case of an urgent Medical issue, please call 707-521-4500
For an urgent Behavioral Health issue, please call 707-521-4550
*Please remember to order and pick up your prescription(s).

TODAY! September 2023 SCIHP Veggie Day
*Remember to bring your reusable bags!*
Santa Rosa - Starts at 11AM on Thursday, September 14th (Located at 3771 Cleveland Ave)

TOMORROW
MPA - Starts at 10AM on Friday, September 15th
Kashia - Starts at 1PM on Friday, September 15th
*WHILE SUPPLIES LAST
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TODAY! September 2023 SCIHP Veggie Day 
*Remember to bring your reusable bags!*
Santa Rosa - Starts at 11AM on Thursday, September 14th (Located at 3771 Cleveland Ave)

TOMORROW
MPA - Starts at 10AM on Friday, September 15th
Kashia - Starts at 1PM on Friday, September 15th
*WHILE SUPPLIES LAST

Breast Cancer Screening Event
Tuesday, October 10th, 2023
8AM-4:30PM @ 3771 Cleveland Ave., Santa Rosa, CA
Resources from SCIHP departments including WIC, Behavioral Health & Healthy Traditions will be available from 10AM-2PM. Please join us in supporting this important screening event.

Call Medical at (707) 521-4500 to schedule your appointment!
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Breast Cancer Screening Event
Tuesday, October 10th, 2023
8AM-4:30PM  @ 3771 Cleveland Ave., Santa Rosa, CA
Resources from SCIHP departments including WIC, Behavioral Health & Healthy Traditions will be available from 10AM-2PM. Please join us in supporting this important screening event.

Call Medical at (707) 521-4500 to schedule your appointment!

Learn more about what's going on inside your body! Check out this article from the AARP Magazine - "The Inside Story of Your Body" by Eric Spitznagel ... See MoreSee Less

Learn more about whats going on inside your body! Check out this article from the AARP Magazine - The Inside Story of Your Body by Eric SpitznagelImage attachmentImage attachment+1Image attachment

Car Seat Fitting Station
Attend this FREE event to have your car seat or booster checked for expiration & learn how to keep your infant, toddler, or child safe when you travel.
SCIHP NATIVE CHILDREN
Friday, October 6th, 2023 BY APPOINTMENT ONLY
10AM - 3PM
SCIHP Clinic Parking Lot-Stony Point Side
Call (707) 521-4606 or (707) 521-4649 to schedule an appointment & to check if you meet SCIHP eligibility for a new car seat.
... See MoreSee Less

Car Seat Fitting Station
Attend this FREE event to have your car seat or booster checked for expiration & learn how to keep your infant, toddler, or child safe when you travel.
SCIHP NATIVE CHILDREN
Friday, October 6th, 2023 BY APPOINTMENT ONLY
10AM - 3PM
SCIHP Clinic Parking Lot-Stony Point Side
Call (707) 521-4606 or (707) 521-4649 to schedule an appointment & to check if you meet SCIHP eligibility for a new car seat.
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