Summary of Insurance Services
CCOH doctors are participating providers for Medicare and are contracted with most major insurance plans. HMO insurance plans accepted are Dignity Health Medical Network and Kaiser Permanente of Santa Cruz. HMO's require a referral and authorization.
Check with your insurance plan to ensure that the doctor you choose is a contracted provider. When you are referred to one of our doctors, an insurance verification and eligibility check will be performed by our experienced staff. Your insurance benefits are determined through this process and once benefits are determine, you will be provided with a written summary. If authorization is required (which is almost always the case) we will initiate that request on your behalf.
Accepted Insurance
Accepted insurance plans include: Medicare, Blue Cross, Blue Shield, Aetna, Cigna, HealthNet, United HealthCare and others.
Summary of Financial Services
If our doctors determined that you need treatment, an estimate of the treatment costs will be provided to you. The estimate will break down the insurance and patient portions of your insurance coverage. This estimate will give you a complete picture of the financial responsibility of both you and your insurance company for treatment received in our office. This is a valuable service to you and your family. With this information you can make an informed decision about your treatment and financial options.
Your co-pay is due at the time of service as stipulated by your contract with your insurance company. Depending on your insurance benefits, payment may be required at the time of service. Final determination of deductible and co-pays will be made by your insurance company at the time your claim is processed. CCOH has a number of payment options available for your convenience.
No Surprises Act
Your Rights and Protections Against Surprise 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 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.
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.
California state law has similar protections to the federal No Surprises Act, more information can be found at California Department of Managed Care, Surprise Medical Bills Fact Sheet.
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 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 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 Centers for Medicare and Medicaid
Services at CMS at www.cms.gov for your rights under federal law.
For more information about your rights under California state law visit California Department of Managed Health Care at www.dmhc.ca.gov or California Department of Insurance at www.insurance.ca.gov.