Your Rights and Protections Against Surprise Medical Bills
Capstone Family Medicine LLC (Capstone Clinics), in compliance with Section 2799B-3 of the Public Health Service Act (PHS Act), has prepared this page to explain the rights of our patients with regard to 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 healthcare provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn't in your health plan's network.
"Out-of-network" means providers and facilities that haven't signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 plan's deductible or 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You're 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 they can bill you is your plan's in-network cost-sharing amount (such as copayments, coinsurance and deductibles). 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 balance 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 can 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 types of 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 out-of-network care. You can choose a provider or facility in your plan's network.
When balance billing isn't allowed, you also have these protections:
You're only responsible for paying your share of the cost (like the copayments, coinsurance and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
Generally, your health plan must:
-
Cover emergency services without requiring you to get approval for services in advance (also known as "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 in-network deductible and out-of-pocket limit.
​
​
Think you've been billed wrong?
If you think you've been wrongly billed, contact the No Surprises Help Desk at 1-800-985-3059. This is the federal phone number for information and complaints. You can also contact the Alaska Division of Insurance at (907) 269-7900, insurance@alaska.gov, or https://www.commerce.alaska.gov/web/ins/Consumers/Complaints.aspx. For billing questions, you can always call the Capstone Clinics billing office at 907-357-9590 (TTY: 711).
Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Your right to a Good Faith Estimate
If you don't have health insurance, or you choose not to use it, you have the right to receive a Good Faith Estimate of how much your care will cost. You can ask before you schedule, and you will get one when you schedule care at least 3 business days ahead. If your bill is at least $400 more than your estimate, you can dispute the bill. To ask for a Good Faith Estimate, contact Micky Boyer at 907-357-9590 (TTY: 711) or mboyer@capstoneclinic.com, or ask at any Capstone Clinics front desk. This includes cash-pay patients. Direct Primary Care (DPC) is not insurance; DPC members who pay for a service out of pocket can also ask. Under Alaska law, you will be provided with an estimate of the anticipated charges for your nonemergency care upon request. Please do not hesitate to ask for information. For more information, visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059.
Read the Good Faith Estimate Notice
Price information: Capstone Clinics has filed its list of prices for our most common services with the Alaska Department of Health, as required by AS 18.23.400. You can view Alaska provider price lists at https://health.alaska.gov/en/education/price-transparency-medical-providers/. The undiscounted prices may be higher or lower than the amount you actually pay.
Important
We do not offer life-saving services and/or procedures. If you have an emergency, call 911 or go to the nearest emergency room.
ATTENTION: If you speak a language other than English, free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. Call 1-907-357-9590 (TTY: 711) or speak to your provider.
Non-Discrimination and Unbiased Entity Statement
Capstone Clinics does not discriminate on the basis of race, color, national origin, age, disability, or sex. We provide free language help and free aids and services for people with disabilities. Questions or grievances: Micky Boyer, Section 1557 Coordinator, 907-357-9590 (TTY: 711), mboyer@capstoneclinic.com.