No Surprises Act

Purpose

To inform you—our patient—of your rights and protections under the federal “No Surprises Act” and to explain how Magnolia Health PLLC complies with these requirements.

Scope

This policy applies to all patients receiving services at Magnolia Health PLLC, whether you have insurance, are self-paying, or are uninsured.

Key Definitions

1. Balance Billing (Surprise Billing): When a provider bills you for the difference between the provider’s charge and the amount your insurer pays.
2. In-Network Provider/Facility: A provider or facility that has a contract with your health plan.
3. Out-of-Network Provider/Facility: A provider or facility that does not have a contract with your health plan.
4. Good Faith Estimate: An itemized written estimate of expected charges for medical items and services.

Your Rights Under the No Surprises Act

Emergency Services

If you receive emergency care, you cannot be balance-billed, even if the provider or facility is out-of-network.

You will only owe your in-network cost-sharing amounts (e.g., copays, coinsurance).

Non-Emergency Services at In-Network Facilities

If you schedule a non-emergency service at an in-network facility but are inadvertently treated by an out-of-network provider (for example, an anesthesiologist or radiologist), you cannot be balance-billed for that provider’s services.

You owe only your in-network cost-sharing.

Good Faith Estimate for Uninsured or Self-Pay Patients

If you do not have insurance or choose to self-pay, you have the right to receive a Good Faith Estimate of expected charges.

You may request this estimate up to one year in advance of scheduled care.

How to Obtain a Good Faith Estimate

• Request in Writing or by Phone
• Submit your request to our Billing Department at least 3 business days before your scheduled service.
• Email: contact@magnolia-health.org
• Phone: (828) 220-4174

What You’ll Receive

1. An itemized list of expected charges for all items and services.
2. Any assumptions made (e.g., length of visit, typical supplies).

Timing

If you request at least 3 business days before care, we must provide the estimate within 3 business days of your request.

If you request fewer than 3 business days before care, we’ll provide the estimate within 1 business day.

Disputing a Bill

If you receive a bill that is higher than your Good Faith Estimate by more than $400, you have the right to dispute it:

• Contact our Billing Department within 120 days of the date on your bill.
• We will initiate a Independent Dispute Resolution (IDR) process with an external reviewer.
• You owe only the lower of:
  • The disputed amount, or
  • Your original Good Faith Estimate, plus any applicable in-network cost sharing.

Provider and Facility Obligations

We will notify you in writing of any unexpected changes in cost that exceed $400.

We will provide clear information about your network status and cost-sharing before you schedule non-emergency services.


Additional Information & Contact

If you have questions about this policy or your rights under the No Surprises Act, please contact:

Magnolia Health PLLC – Billing Department
127 East Trade Street, Suite B100
Forest City, NC 28134
Phone: (828) 220-4174
Email: contact@magnolia-health.org

You may also visit cms.gov/nosurprises for more federal guidance on balance-billing protections.

Magnolia Health PLLC is committed to transparent, fair billing practices and to protecting you from unexpected medical bills.