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Surprise Billing

Important Update

On Dec. 9, 2021, both the American Hospital Association (AHA) and the American Medical Association (AMA) sought to have the No Surprises Act temporarily halted by the courts. Memorial will continue providing transparent information on the No Surprises Act here as well as updates that may come from this legal challenge.

What is the "No Surprises Act?"

On Jan. 1, 2022, the “No Surprises Act” took effect. This law provides patients within Memorial Health facilities – and across the country – protections from being balance billed in emergency situations in which you receive services from an out-of-network provider. Within a hospital facility, there may be a number of providers who are not a part of Memorial Health. Those providers contract with insurance companies outside Memorial Health to be ‘in-network.’ However, there are situations in which these providers have disputes with the insurance company and may become out of network.

While the services billed by a Memorial Health facility may be in network, the provider, or professional services, may not be in network due to the above mentioned contract dispute situation. Because of that, the provider may choose to “balance bill” you. “Balance billing” is when a provider bills you for the difference between:

  • The provider's charge for the service, and
  • The allowed, or covered, amount from your insurance company

An example would be receiving a service with a $100.00 charge. The allowed, or covered, amount from your insurance company is $70.00. Prior to the passage of this law the provider could ‘balance bill’ you for the difference, or $30.00. Even though the provider cannot seek the difference here after Jan. 1, 2022, you may still be responsible for higher co-pays and deductibles due to the provider being out of network.

For non-emergency services, the out-of-network provider can only "balance bill" you if you are provided notice of their out-of-network status and consent to being balanced billed. 

Good Faith Estimates

For those without insurance or self-pay, the new law affords you the ability to request a good faith estimate that will help you understand the costs associated with an outpatient procedure. Over the last year, Memorial has put into place an interactive price estimator that can help you determine the cost of services rendered at a Memorial Health facility. Additionally, Memorial is expanding our capabilities to help those who are without insurance or self-pay determine whether they qualify for State of Illinois Medicaid, Medicaid Managed Care coverage or financial assistance.

Below is an interactive way in which you can determine how to obtain information on the cost of services or opportunities to obtain insurance coverage or financial assistance:

Ways Memorial wants to help you:

Check whether you qualify for coverage.

Memorial facilities work with partners in all of our regions to assist you in checking whether you qualify for expanded Illinois Medicaid or Medicaid Managed Care coverage. We encourage you to reach out to contact a Patient Financial Service representative and begin working with our team to determine whether you qualify.

This process does take time. We recommend reaching out early in your planning process and prior to scheduling your procedure to begin the eligibility review process. You may refer to our insurance page to see which plans we accept in the area in which you reside. Having insurance prior to your scheduled visit will help give you peace of mind – and will allow for you to access a broad network of providers dependent on the plan you qualify for and select.

If you don’t qualify for coverage, do you qualify for financial assistance?

Our partners will assess whether you qualify for financial assistance. Obtaining financial assistance prior to your scheduled procedure will help give you peace of mind knowing you have financial assistance prior to being billed. If you qualify, your bill received will reflect the financial assistance amount awarded. For more information, please visit our financial assistance page.

If you don’t qualify for either coverage or financial assistance ...

There are some situations in which you may not qualify for either. In these cases, you would be considered a self-pay patient – and responsible for the discounted cost of services received. Memorial does offer a free price estimator you can navigate without the need to create a user name or log-in. Our price estimator allows you to run price estimates on all procedures and print them off for your records. Please visit our estimator to begin your planning process. Should you have questions on how to navigate this process or wish to have a handwritten good faith estimate, please reach out to RevenueIntegrity@mhsil.com and we will be glad to assist you.

Finally, for those patients who need to finance their healthcare, Memorial facilities offer 0% financing with flexible terms. For more information, please visit our page here.

Our commitment to you.

We know surprise billing and good faith estimates are new to healthcare. Just like price transparency, we are working hard to give you the tools to help you plan your healthcare needs with us. Our goal is to help you focus on healing and not the billing aspect of healthcare. Helping you navigate the insurance eligibility or financial assistance process for scheduled procedures is just one part. As a community leader, we desire for all of our patients to have the tools and resources necessary to make the best healthcare decision they can.

To that end, we are including some frequently asked questions below to help educate you and your family on this new law – as well as notices that will be communicated in both the emergency department and registration points at a Memorial Health facility.

FREQUENTLY ASKED QUESTIONS

Balance Billing

1. How will I be notified about balance billing protections at a Memorial facility?

a. Memorial facilities are required to post notification of balance billing protections within our emergency rooms and registration areas. For ease, we will include these notifications below for you and your family to review prior to your visit.

2. What am I protected from?

a. You are protected from being balance billed from out-of-network providers in the event you receive emergency services at a Memorial Health facility.

3. Will I receive notification of my rights when I receive a statement?

a. Yes! Memorial will include balance billing protection information when you receive a statement for services received at a Memorial facility.

4. Are protections for hospital-only services?

a. Balance billing provides protection for you in emergency situations. While Memorial facilities are in network for a broad number of plans, our independent physician partners who practice in our hospitals can choose whom they participate with as in-network providers. Balance billing protects you when an independent physician provider who practices within a Memorial facility chooses to be out of network with an insurance plan.

5. Can I see an out-of-network provider in a non-emergency situation?

a. Patients receiving non-emergency care will be required to receive a notice that the provider treating them in the hospital is out of network and whether you consent to being balance billed.

6. Who do I contact if I feel I was balance billed?

a. You may contact the Center for Medicare and Medicaid Services (CMS) No Surprises Act Center at: 800-985-3059 or visit CMS’ portal on surprise billing at www.cms.gov/nosurprises.

7. My independent provider is out of network. What will my impact be for out-of-pocket benefits?

a. Memorial Health cannot provide estimates of your out-of-pocket benefits. Only the independent provider or your insurance carrier can give you this information. For ease, we have most major carrier websites included here for ease in obtaining this information.

Good Faith Estimate

1. What is included in the Good Faith Estimate?

a. The estimate will include charges for services we anticipate you will receive based upon the scheduled procedure. At this time, however, we are unable to include charges that may be incurred by non-Memorial providers.

2. How can I request a Good Faith Estimate?

a. Estimates can be obtained by emailing RevenueIntegrity@mhsil.com. You may also visit our patient estimator here. We are working to expand the number of procedures we can provide estimates for that are driven by our patients.

3. When will I receive a Good Faith Estimate?

a. Estimates for uninsured and self-pay patients are required by law to be provided to you in a timely manner and before your procedure. When you schedule your procedure, our teams will work to compile the estimate and deliver it to you either electronically (email) or through U.S. mail.

Continue to check this page for more information on balance billing protections. Memorial will update here as more information about this law continues to be pushed out.

Below is a link to the required notice we will be display within our emergency room and registration areas.

suprise-billing

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