Surprise Billing and Balance Billing Protections

At Orthopaedic Associates of Marlborough, we understand that healthcare billing can be confusing, and we are here to help.

What do the terms Balance Billing and Surprise Billing mean?

Surprise Billing occurs when a patient receives a larger-than-expected medical bill due to their care provider being out-of-network. It typically occurs in the following scenarios:

• Emergency care situations, when patients may not be able to choose health care providers covered by their insurance.
• An out-of-network provider renders service to a patient at an in-network hospital.

Balance Billing happens when an out-of-network provider holds a patient responsible for the difference between their gross charge and the insurer’s allowed amount.

It’s important to understand your rights and protections against surprise medical bills.  Below are some links to more information:

• Your Rights and Protections Against Surprise Medical Bills
• Participating OAM Insurance Plans
• Right to Receive a Good Faith Estimate

Should you have any questions regarding billing or insurance, please contact our Office Manager
Monday-Thursday 9 am – 4:30 pm at 508-485-3665 and we will be happy to assist you.