No Surprises Act Disclosure

Your Rights and Protections Against Surprise Medical Bills
At Southern Live Oak Wellness, we are committed to transparency and protecting our clients from unexpected medical costs. The No Surprises Act is a federal law that protects you from surprise billing when you receive care from out-of-network providers at in-network facilities or during emergency services.

What is a Surprise Medical Bill?
When you receive care from an out-of-network provider or facility, you may be billed for the difference between what your health plan covers and what the provider charges. This is called balance billing, and in many cases, it can result in higher out-of-pocket costs.
You Are Protected From Balance Billing:
When receiving emergency care or certain non-emergency services at an in-network facility, federal law prohibits out-of-network providers from:

• Charging you more than your in-network cost-sharing amount (such as copayments, coinsurance, or deductibles)
• Billing you for additional costs outside of what your health plan covers without your consent

These protections apply even if you receive services from an out-of-network provider at an in-network facility.
You Are Also Entitled To:

• A Good Faith Estimate: If you are uninsured or self-pay, you have the right to receive a written estimate of the expected charges for your treatment in advance of services.
• A clear explanation of costs: Before treatment begins, you may request a list of expected charges, including for any laboratory, therapy, or ancillary services.

If You Believe You Were Wrongfully Billed
If you think you have received a surprise bill or have concerns about your rights under the No Surprises Act, you can contact:

• The Centers for Medicare & Medicaid Services (CMS):
 Call 1-800-985-3059 or visit www.cms.gov/nosurprises

You may also file a complaint with Southern Live Oak Wellness by contacting us directly using the information below.