University Urology, PC  ·  Patient Rights

Your Rights and Protections Against Surprise Medical Bills

Required Notice Under the Federal No Surprises Act  ·  Effective January 1, 2022  ·  universityuro.com/no-surprise-billing

Federal Law Protects You from Unexpected Out-of-Network 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. This notice explains your rights and what University Urology is required to tell you.

Overview

What Is Surprise Billing?

A surprise bill — also called a balance bill — happens when you receive care from an out-of-network provider and are billed for the difference between what your insurance pays and the provider's full charge. This can occur even when you did not intentionally choose an out-of-network provider, such as in an emergency or when an out-of-network specialist is involved in your care at an in-network facility.

University Urology participates in most major insurance networks in East Tennessee. Before your visit, we encourage you to verify your coverage by calling your insurance company or our billing team at (865) 444-0889. If we are out-of-network for your plan, we will inform you of your options.

Your Protections

When These Protections Apply to You

Federal law protects you from balance billing — and from being charged more than your in-network cost-sharing (deductibles, copays, and coinsurance) — in the following situations:

Emergency Care

If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility, you cannot be billed more than your in-network cost-sharing amount. This protection applies to emergency care at any hospital or emergency facility, regardless of whether the provider is in your network. It also applies to post-stabilization services unless you provide written consent and are able to travel safely to an in-network provider.

Non-Emergency Care at In-Network Facilities

If you receive non-emergency care from an out-of-network provider at an in-network hospital or ambulatory surgical center, you cannot be balance billed unless you give your written consent and agree to waive these protections. There are certain ancillary services — such as those provided by anesthesiologists, radiologists, or pathologists — for which consent to balance billing is not permitted at all, even if you agree in writing.

Out-of-Network Air Ambulance Services

If you require air ambulance transport and the air ambulance provider is out-of-network, federal law limits your cost-sharing to your in-network amount. Air ambulance providers cannot balance bill you for the difference.

If you believe you have been billed in violation of these protections, see the complaint information at the bottom of this page.

Your Costs

What You May Still Owe

These protections limit how much you are charged — but do not eliminate all cost-sharing. You may still be responsible for the following, based on your insurance plan:

Deductible

The amount you pay out-of-pocket before your insurance begins to cover most services. Your in-network deductible applies.

Copay

A fixed amount you pay per visit or service. Co-pays are collected at the time of your visit at University Urology.

Coinsurance

Your share of the cost after the deductible is met, typically expressed as a percentage (e.g., 20%).

Out-of-Network Cost-Sharing (With Consent)

If you voluntarily receive non-emergency care from an out-of-network provider and sign a valid consent form waiving your protections, you may owe more.

For questions about your specific cost-sharing obligations, contact your insurance company using the member services number on your insurance card. For billing questions specific to University Urology, contact our billing team at (865) 444-0889.

Uninsured & Self-Pay Patients

Good Faith Estimates

If you are uninsured or are not planning to use your insurance for a service, you have the right to receive a Good Faith Estimate of the expected cost of your care before your visit.

Your Right to a Good Faith Estimate

Under the No Surprises Act, health care providers must give patients who do not have insurance — or who choose not to use their insurance — a written estimate of the expected cost of items and services before the scheduled service or upon request.

Your Good Faith Estimate will include a list of services University Urology reasonably expects to furnish for your visit, the estimated cost of each service, and the name and contact information of each provider involved. It is not a final bill and actual costs may vary based on your specific medical situation.

If you receive a bill for $400 or more above your Good Faith Estimate, you have the right to dispute the bill through the Patient-Provider Dispute Resolution (PPDR) process administered by the federal government. You must initiate the dispute within 120 calendar days of receiving the bill that exceeds your estimate.

How to Request a Good Faith Estimate

To request a Good Faith Estimate before a scheduled service, contact our billing team at least three business days before your appointment:

  • Phone: (865) 444-0889 — Billing Department
  • Fax: (865) 244-1611
  • Mail: University Urology, PC — Billing, 1928 Alcoa Highway, Building B, Suite 222, Knoxville, TN 37920

Please have your name, date of birth, and the name or description of the service(s) you are requesting an estimate for available when you call.

Exceptions

When These Protections Do Not Apply

The No Surprises Act protections apply to most private insurance plans, including employer-sponsored plans, individual and family plans purchased on or off the Health Insurance Marketplace, and certain other plans. However, these protections do not apply to patients covered by the following programs:

Excluded Coverage Types

  • Medicare (Parts A, B, C, and D)
  • Medicaid and TennCare
  • Veterans Affairs (VA) Health Care
  • TRICARE (military health coverage)
  • Indian Health Service (IHS)
  • Federal Employees Health Benefits (FEHB) program (note: FEHB plans have separate but similar protections)
  • Short-term limited duration health plans
  • Excepted benefits (e.g., stand-alone dental or vision-only coverage)
  • Health care sharing ministry plans

Patients covered by Medicare, Medicaid, or TennCare have separate protections under those programs. For questions about your specific coverage, contact your plan directly or call us at (865) 305-9254.

Consent to Out-of-Network Care

When You May Be Asked to Sign a Consent Form

In limited circumstances, an out-of-network provider at an in-network facility may ask you to sign a consent form agreeing to receive care from that provider and acknowledging that you may owe more than your in-network cost-sharing amount. This consent is voluntary and you are not required to sign.

You cannot be asked to sign a consent form waiving surprise billing protections for:

  • Emergency services
  • Post-stabilization services when you cannot safely travel to an in-network provider
  • Ancillary services provided by out-of-network radiologists, anesthesiologists, pathologists, neonatologists, assistant surgeons, or hospitalists at an in-network facility

If you are ever unsure whether you are being asked to sign away protections you are entitled to keep, contact your insurance company or file a complaint using the information below.

Questions & Complaints

How to Get Help or File a Complaint

If you believe you have been billed in violation of the No Surprises Act, or if you have questions about your rights, several resources are available to you.

University Urology Billing Department

For billing questions, to request a Good Faith Estimate, or to discuss a specific bill from University Urology, contact our billing team directly:

Phone: (865) 444-0889

Fax: (865) 244-1611

Hours: Monday–Friday, 8:00 AM – 4:30 PM

Our front desk and clinical staff are not able to resolve billing disputes at the clinic level. Please contact the billing department directly for all billing matters.

Federal Resources

To file a complaint with the federal government or to learn more about your rights under the No Surprises Act:

  • CMS No Surprises Help Desk: 1-800-985-3059 (TTY: 1-800-985-3059)
  • Online complaint form: cms.gov/nosurprises
  • Patient-Provider Dispute Resolution (PPDR): If your bill exceeds your Good Faith Estimate by $400 or more, you may initiate a dispute at cms.gov/medical-bill-rights

Tennessee Department of Commerce & Insurance

Tennessee residents may also contact the state insurance regulator for questions about state-level balance billing protections:

University Urology, PC  ·  1928 Alcoa Highway, Building B, Suite 222, Knoxville, TN 37920  ·  (865) 305-9254  ·  universityuro.com
This notice is provided in compliance with the No Surprises Act (Consolidated Appropriations Act, 2021, Division BB, Title I) and implementing regulations. It is effective January 1, 2022, and applies to all University Urology, PC locations.  ·  Privacy Policy