TRUTH AND TRANSPARENCY

At Diversified Benefit Administrators, Inc., we feel the only way to conduct business is by doing so as openly and honestly as we can.  Several new laws have been enacted that require all entities handling health insurance to provide transparency to their members.  We take those laws very seriously and want to provide the most up to date information we can. Therefore, Diversified Benefit Administrators, Inc., in accordance with the Centers for Medicare and Medicaid (CMS), want to provide the required transparency to its members.  Below is a link to our Machine Readable File.  For more information, please see  Compliance with Hospital Price Transparency Final Rule: 8 Steps to a Machine-Readable File (cms.gov) for further information regarding Truth and Transparency in Healthcare.

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS

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 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 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 to 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.

If you believe you have been wrongly billed, you may contact any of the following entities:

Department of Health and Human Services (HHS)

Website: https://www.hhs.gov/

Contact: https://www.hhs.gov/about/contact-us/index.html

Main Address: 200 Independence Ave., SW

Washington, DC 20201

Toll Free No Surprises Help Desk: 1-800-985-3059

Forms: https://www.hhs.gov/forms/index.html

To find out what your responsibility will be for any upcoming procedures, please follow these

instructions:

In a web browser, type in https://sgbwww.ebixhealth.com/lin/faces/LinLogin.jsp?themeProfile=sgba

After entering your username and password, select "Document Library/Transparency".  If you are unable to find the Transparency link, please contact our office at 844-200-7422.

For additional information, please select the Frequently Asked Questions document below.