Billing & Privacy Policies
Billing Policies
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
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, like a copayment, coinsurance, or deductible. You may have additional 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” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 plan’s deductible or 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You’re 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 they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). 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.
Additionally, Missouri protects patients from surprise medical bills for health care services at an in-network facility from an out-of-network provider from the time the patient presents with an emergency medical condition until the patient is discharged.
Certain services at an in-network hospital or ambulatory surgical senter
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 can 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 types of 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 out-of-network care. You can choose a provider or facility in your plan’s network.
Additionally, Missouri law requires that patients pay only their in-network cost sharing amounts. These protections apply to any patient covered by a state regulated insurance plan but does not apply to a liability insurance policy, workers’ compensation insurance policy, or medical payments insurance issued as a supplement to a liability policy.
When balance billing isn’t allowed, you also have these protections:
You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities.
Generally, your health plan must:
• Cover emergency services without requiring you to get approval for services in advance (also known as “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 in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, you may contact:
• The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit www.cms.gov/nosurprises for more information about your rights under federal law; or
• The Missouri Department of Insurance at 1-800-726-7390 or by visiting https://insurance.mo.gov/ for more information about your rights under state law.
Refunds
If you need to request a refund for any reason, please contact Sana Lake Accounts Receivable at AR@SanaLake.com or 636-944-4400. Refunds will be applied first to the debit or credit card used when possible. All other refunds will be delivered by check payable to the client. Please note Sana Lake does not control the timing for process of refunds by your card issuer or bank. Additionally, refunds will not be processed by Sana Lake until Sana Lake receives adjudications on all insurance proceeds due on your account. There are NO REFUNDS for products sold or services rendered. Accounts paid in advance of services being rendered will be refunded, when applicable, in an amount equal to the advance payment less the amount due for services rendered in accordance with the fee schedule, and your deductible, co-insurance, out-of-pocket maximum amounts, other non-covered services rendered, and other fees identified in this agreement.
Members are responsible for their deductible, co-insurance, and out-of-pocket maximums. No refunds will be issued for services rendered and for the member responsibility paid towards these services unless payments have been made in excess of member responsibility.
Members are responsible for the cost of services rendered with self-pay options chosen. In the event that members pre-pay for services then payments will be applied for each day and/or service rendered according to the Self Pay fee schedule. Should a general discount be provided for an entire episode of care, any refunds for time or services unused are prorated according to the self-pay fee schedule. No refunds are provided for Inpatient Detoxification after admission when these services are paid for in advance. For bundled pricing that includes inpatient detoxification and residential care, refunds are processed for members discharged between 8 and 21 days in care. Any discharge prior to the 8th day or following the 21st day will not be eligible for refunds.
For questions and disputes please contact Sana Lake Accounts Receivable at AR@SanaLake.com or 636-944-4400
Privacy Policy
Use and Disclosures of Health Information Treatment, Payment, Health Care Operations
Sana Lake Recovery Center uses and discloses your protected health information for treatment, payment, and health care operations. Some examples of when our office may use or disclose your health care information for these purposes include:
- Sharing test results with other health care providers for confirmation of a diagnosis
- Providing your diagnosis or other information about your health to your insurance provider or our billing service to obtain payment for the health care services we provide
- Reviewing information as part of our quality improvement program
Other Use and Disclosures
Sana Lake Recovery Center may also use or disclose your protected health information, in compliance with guidelines outlined by law, for the following purposes:
- Providing you with information related to your health
- Contacting you regarding appointments, information about Sana Lake Recovery Center or other health related services
- Incidental uses or disclosures (e.g., listing your name on a sign-in sheet, etc.)
- Compliance with all laws (including reports of suspected abuse, neglect or violence)
- Providing certain specified information to law enforcement or correctional institutions
- Information disclosed in the course of a visit by a licensing/regulatory/accrediting body
- Public health activities when requested by a public health authority or the FDA. Responding to health oversight agencies
- Responding to court or administrative tribunal orders, subpoenas, discovery requests, or other lawful process
- Research activities
- When necessary to avert a serious threat to health or safety
- Military affairs, veterans affairs, national security, intelligence, Department of State, or presidential protective service activities
- Providing information regarding your location, general condition, or death, to public or private disaster relief agencies
- Providing information to a family member, other relative, or close personal friend, relative to your location, general condition, or death
- To assist in your health care (e.g. pick-up prescriptions or other documents, note follow-up care instructions, etc.)
Authorization for Other Uses
Sana Lake Recovery Center will make other uses and disclosure of your protected health information only after obtaining your written authorization. If you authorize a use not contained in this notice, you may revoke your authorization at any time by notifying us that you wish to revoke your authorization.
Your Rights Regarding the Privacy of Your Health Information
Subject to limitations outlined by law, you have certain rights related to use and disclosure of your protected health information, including the right to:
- Request restrictions on certain uses and disclosures. However, Sana Lake Recovery Center is not obligated to agree to requested restrictions.
- Receive confidential communications (e.g., home phone, work phone, etc.) or protected health information. We will comply with reasonable requests.
- Request to see or receive an electronic or paper copy of your medical record and other health information we have about you.
- Inspect and copy your protected health information, with some limited exceptions.
- Request that we amend or correct your private health information. We may deny your request, but we will notify you of the reason why in writing.
- Receive an accounting of disclosures of your health information, for a period of six (7) years after your discharge, except for disclosures made at your request, or relative to your treatment, payment, or our Sana Lake Recovery Center operations.
- Request that someone act on your behalf, for example, by giving someone medical power of attorney, or by appointing someone as your legal guardian.
- Obtain a copy of this notice. We will provide you with a paper copy of the notice promptly upon your request.
Sana Lake Recovery Center's Duties Regarding the Privacy of your Health Information
Subject to limitations outlined by law, Sana Lake Recovery Center has certain duties related to your protected health information, including:
- Sana Lake Recovery Center is required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information.
- Sana Lake Recovery Center is required to abide by the terms of the privacy notice that is currently in effect.
- Sana Lake Recovery Center reserves the right to change a privacy practice described in this notice and to make such change effective for all protected health information. Revised notices will be posted in our offices, on our website, and available upon request.
- Sana Lake Recovery Center is required by law to let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- Sana Lake Recovery Center will not use your information other than as described in this patient privacy policy unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
Concerns
If you believe your privacy rights have been violated, you may make a complaint by contacting:
Sana Lake Recovery Center
150 Sana Lake Recovery Way
Dittmer, MO 63023
(314) 664-9931
