Gainesville emergency medical associates billing

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.

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.

Many states have specific state laws to determine payments from insurers. Click here to view a list of state-specific information.

If no state law applies or if you think you’ve been wrongly billed, contact the federal regulators responsible for enforcing the federal surprise billing protection laws at 1-800-985-3059.

Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.

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Hours of Operation:

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Weekdays

Monday

Tuesday

Wednesday

Thursday

Friday

8:00am – 8:00pm

8:00am – 8:00pm

8:00am – 8:00pm

8:00am – 8:00pm

8:00am – 8:00pm

Weekends - Tower 24

10:00 am - 4:00 pm

10:00 am - 4:00 pm

Weekends - NW 39th Avenue

10:00 am - 4:00 pm

10:00 am - 4:00 pm

HIGH ACUITY URGENT CARE

for adults and children

Emergency Physicians Medical Center

is closed on the following holidays

to celebrate with family:

• New Year's Day

• Easter Sunday

• Independence Day

• Thanksgiving

• Christmas Day

Emergency Physicians Medical Center offers an alternative for all emergency department patients who don’t require admission to a hospital. We are a full-service, walk-in medical clinic for all ages. We treat a wide range of minor to serious illnesses and injuries so we can keep you out of the ER and often out of the hospital.

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Our medical staff is made up of board-certified emergency room physicians with over 60 years of combined emergency care experience. 

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We are open 7 days a week. No appointments are required for urgent care - simply walk in and a member of our dedicated and compassionate staff will see you as soon as possible.

For Rapid Covid-19 testing, patients can walk in to one of our two locations. We do not offer the PCR Covid test or Covid vaccines.

Rapid COVID-19 testing

New Patient?

• EMERGENCY CARE

• ON-SITE LAB

• IV FLUIDS and MEDICATIONS

• DIGITAL X-RAY

• ULTRASOUND

• OCCUPATIONAL MEDICINE

• WORKER'S COMPENSATION

• WELLNESS SCREENINGS AND PHYSICAL EXAMS

• AVIATION MEDICAL EXAMS 

• VACCINATIONS AND IMMUNIZATIONS

Our walk-in clinics serve patients within

a 50 mile radius of Gainesville, FL

Questions?  Comments?

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