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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 should not 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 must 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.
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 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.
State Specific Rules
California law protects enrollees in state regulated plans from surprise medical bills when the following occur:
(a) an enrollee receives emergency services from a doctor or hospital that is not contracted with the patient's health plan or medical group; or
(b) an enrollee receives scheduled care at an in-network facility such as a hospital, lab, or imaging center, but services are delivered by an out-of-network provider.
In covered circumstances, providers cannot bill consumers more than their in-network cost sharing. Further, for uninsured individuals, hospitals must provide the patient with a written estimate of the amount the hospital will require for the expected services at the time of service.
California Department of Insurance
Phone: 1-800-927-4357
website: https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm or http://www.insurance.ca.gov/01-consumers/101-help/index.cfm
When balance billing isn’t allowed, you also have these protections:
If you think you’ve been wrongly billed, contact 1-800-985-3059. Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.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 should not 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 must 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.
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 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.
State Specific Rules
California law protects enrollees in state regulated plans from surprise medical bills when the following occur:
(a) an enrollee receives emergency services from a doctor or hospital that is not contracted with the patient's health plan or medical group; or
(b) an enrollee receives scheduled care at an in-network facility such as a hospital, lab, or imaging center, but services are delivered by an out-of-network provider.
In covered circumstances, providers cannot bill consumers more than their in-network cost sharing. Further, for uninsured individuals, hospitals must provide the patient with a written estimate of the amount the hospital will require for the expected services at the time of service.
California Department of Insurance
Phone: 1-800-927-4357
website: https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm or http://www.insurance.ca.gov/01-consumers/101-help/index.cfm
When balance billing isn’t allowed, you also have these protections:
If you think you’ve been wrongly billed, contact 1-800-985-3059. Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Privacy Policy
PRIVACY POLICY
Last updated: February 6, 2023
This Privacy Policy describes how Atown Labs, Inc. (Atown Labs LLC) “we,” “us,” or “our”) collects and uses Personal Information that you may provide to us. Atown Labs places a great value on your privacy. We request that you carefully read this Privacy Policy and our terms and conditions of use before using Atown labs Website. By visiting, viewing, or using the Website in any manner, including the creation and use of a customer account, you are agreeing to the terms set forth in this Privacy Policy as well as the Terms and Conditions of Use for the Website.
If you do not provide certain Personal Information, it may delay or prevent us from providing certain services to you.
The information we collect automatically is statistical data and does not include Personal Information. It helps us to improve our website www.atownlabs.com and to deliver a better service.
The technologies we use for this automatic data collection may include cookies (or browser cookies). A cookie is a small file placed on the hard drive of your computer. You may refuse to accept browser cookies by activating the appropriate setting on your browser. However, if you select this setting, you may be unable to access certain parts of our website. Unless you have adjusted your browser setting so that it will refuse cookies, our system will issue cookies when you direct your browser to our website.
We may use third party analytics, including Google Analytics. You can opt out from the use of Google Analytics by downloading and installing the Google Analytics Opt-out Browser Add On.
In addition to the foregoing, the table below provides examples of how we may use your Personal Information and our reasons for such use:
How we may use your Personal Information
Our reasons
To provide services to you
For the performance of our agreement with you or to comply with your requests
To prevent and detect fraud against you or us
For our legitimate interests or those of a third party, i.e. to minimize fraud that could be damaging for us and for you
Processing necessary to comply with professional, legal and regulatory obligations that apply to our business
To comply with our legal and regulatory obligations
Ensuring business policies are adhered to, e.g. policies covering security and internet use
For our legitimate interests or those of a third party, i.e. to make sure we are following our own internal procedures, so we can deliver the best service to you
Operational reasons, such as improving efficiency, training and quality control
For our legitimate interests or those of a third party, i.e. to be as efficient as we can so we can deliver the best service for you at the best price
Ensuring the confidentiality of commercially sensitive information
For our legitimate interests or those of a third party, i.e. to protect trade secrets and other commercially valuable information; and to comply with our legal and regulatory obligations
Statistical analysis to help us manage our business, e.g. in relation to our financial performance, customer base, product range or other efficiency measures
For our legitimate interests or those of a third party, i.e. to be as efficient as we can so we can deliver the best service for you at the best price
Updating and enhancing customer records
To comply with our legal and regulatory obligations; and for our legitimate interests or those of a third party, e.g. making sure that we can keep in touch with our customers about existing orders and new products
We may also disclose Personal Information that we collect or you provide as described in this privacy policy:
In the preceding 12 months, we have not disclosed for a business purpose to any third parties the following categories of Personal Information:
We will provide this information free of charge up to two (2) times in any twelve (12) month period within 45 days of receiving your verifiable request (including verification of your identity and your California residency), subject to delays and exclusions permitted by law. Specific Personal Information about you or your account that is categorized as sensitive or confidential may be redacted.
For purposes of verifying your identity, please submit your name and address along with your request for Personal Information. We may need to ask for additional verification information depending upon several factors, including our ability to verify your identity and the information requested.
As a California resident, you have the right to request that we delete or correct any Personal Information that we have collected about you. We will honor this request subject to the range of exclusions permitted by law. For example, we are not required to delete Personal Information if it is necessary to complete a transaction or reasonably used for an ongoing business relationship or if it is used internally in a lawful manner that is compatible with the context in which the consumer provided the information.
As a California resident, you also have the right to opt out of the sale of your Personal Information to third parties. We do not sell your Personal Information. However, we are permitted to share your Personal Information with a service provider.
We will not discriminate against you if you choose to exercise any of these rights. California residents may exercise the rights described above by contacting us as follows:
Mail: 9471 El Camino Real Atascadero, CA 93422
Attn: Privacy Officer
Email: admin@atownlabs.com
Phone: 805-464-2641
Fax 805-465-6648
We may require verification of your identity before further processing your request. In certain instances, we may be permitted by law to decline some or all of such request.
Atown Labs will work with the ordering physician to obtain the required prior authorization based upon the requirements established by each payor. When a test is ordered that is deemed as a molecular or genetic test, the laboratory will contact the payor to inquire about what is required. Clinical information and patient history may be requested for submission to the payor to determine medical necessity and coverage criteria. Once a denial or authorization is obtained, the laboratory will contact the provider and/or patient to inform them of the outcome and to educate them regarding their options for testing and financial responsibility.
**Prior authorization approvals are coverage determinations and do not eliminate the patient’s financial responsibility, if applicable. **
Disclaimer:
Use of and access to this website www.atownlabs.com is subject to the following terms and conditions which you are deemed to accept by accessing this website:
Use of Information
We have developed this website to provide you with information relating to our services. The information on this website is general information only and is provided free to you. It is not intended as, nor is it capable of being, advice on any specific problem or a replacement for individual professional medical advice, opinions or therapies advised to you by your medical practitioner. We endeavor to keep the information on this website up to date; however, we make no warranty as to the accuracy, reliability, suitability or currency of information on this website. All information on this website is subject to change at any time. Always seek the advice of a qualified medical professional before acting on the information on this www.atownlabs.com website.
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We are not responsible for, and have no knowledge of, or control over the content of any other websites linked to this website (linked websites). Links to other websites are provided solely to facilitate your easy connection to those websites. We do not sponsor or endorse or accept any liability for the content of those linked websites. Use of any information provided on any linked website is at your sole risk.
Hypertext linking
You must not create a link to any part of this website without our prior written consent. If you do create a link to any page of this website, you acknowledge that you are solely responsible for the consequences of that link and you indemnify and will keep us indemnified against all damages, costs, losses (including without limitation, loss of profits) and expenses of any kind, whether direct or indirect, arising from, or in connection with, that link, whether brought in tort, contract, equity or otherwise.
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We own all copyright and other intellectual property rights in this website. All rights are reserved. You must not copy, display, modify, reproduce, store on a retrieval system, transmit (in any form or by any means), distribute, use for creating derivative works, or use in any other way for commercial or public purposes, any part of this website without our prior written consent. Except where noted, you may download material for your personal, non-commercial use if you:
Retain all copyright and other proprietary notices on each copy and please read our 'extension' privacy policy and terms and conditions that are hyperlinked to the bottom of this website www.atownlabs.com.
Use the material in a manner consistent with these terms of use; and understand that no intellectual property rights or licenses shall be granted to our trademarks, trade names or copyright material
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This website (and the services described in it) are only intended for persons resident in the United States of America. This website is governed by, and is to be interpreted in accordance with, the United States of America laws. To the fullest extent permitted by law, we accept no responsibility for the compliance of the information on this website with the laws of any other country. You agree to indemnify and keep us indemnified against all damages, costs, losses (including, without limitation, loss of profits) and expenses of any kind, whether direct or indirect, arising from, or in connection with, your access to, or use of, this website, whether brought in tort, contract, equity or otherwise.
Warranties
All information on this website is provided 'as is'. To the fullest extent permitted by law, we disclaim all warranties, express or implied, including (without limitation), warranties as to the accuracy, completeness or fitness for any particular purpose.
Liability
We will not be liable for any damages, losses (including, without limitation loss of profits, business or data), costs or expenses of any kind, which arise out of, or result from, any use of, or inability to use, this website or any other website which is linked to this website.
Accessibility
At Atown Labs we are committed to facilitating the accessibility and usability of our website for all customers with disabilities. To that end, we have worked with a leading provider of accessibility technology and services to ensure and maintain accessibility on our website so that we can provide accessible website for our customers to make our website content and services accessible to everyone.
We are in the process of adopting Web Content Accessibility Guidelines (WCAG) Level AA developed by the World Wide Web Consortium (W3C) as our website accessibility standard. We endeavor to update our website regularly to make its content as accessible as possible.
If you have specific questions or concerns about the accessibility of any webpage on www.atownlabs.com, please contact us at admin@atownlabs.com. If you do encounter an accessibility issue, please specify the webpage in your email, and we will use all reasonable efforts to assist you. Thank you for visiting www.atownlabs.com and enjoy use of our website.
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