Surprise Billing

A locally owned and operated radiology practice, TRA has not and does not engage in "surprise billing". The following information regarding your rights and protections with respect to surprise billing is posted below in accordance with federal requirements.

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 providersmay 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 facilitymay 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 deductiblesthat 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 entity responsible for enforcing the federal and/or state balance or surprise billing protection laws.