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.
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other 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” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay 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 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.
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). 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 may 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 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 care out-of-network. You can choose a provider or facility in your plan’s network.
You have the following protections:
Check with your State Department of Insurance to determine if you have balance billing protections under state law.
If no state law applies or if you think you’ve been wrongly billed, contact the federal regulators responsible for enforcing the federal surprise billing protection laws at 1-800-985-3059.
Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Shore Gastroenterology Associates can help with questions concerning billing. Contact us before hand if you have any concerns about the procedures we provide and coverage.
Discrimination is Against the Law
Allied Digestive Health (“ADH”) complies with applicable Federal Civil Rights Laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ADH does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
ADH and its affiliated practices and departments:
If you need these services, contact:
Beverly Coleman, Chief Human Resources Officer and Privacy Officer and Civil Rights Coordinator
Allied Digestive Health
Monmouth Corporate Park 1
187 Highway 36, Suite 230
West Long Branch, New Jersey 07764
compliance@hcompliance.com
844-932-6675
If you believe that ADH or its affiliates has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with Beverly Coleman at the contact information above. You can file a grievance in person or by mail, fax, or email.
If you need help filing a grievance, you may also contact the Privacy Officer, Beverly Coleman, at the contact information listed above for assistance.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue SW Room 509F
HHH Building Washington, DC 20201
1-800-868-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Or you can file a Civil Rights complaint with the New Jersey Division on Civil Rights at the following locations:
Northern Regional Office
31 Clinton Street, 3rd Floor
Newark, NJ 07102
973-648-2700
Fax: 973-648-4405
Central Regional Office
140 East Front Street: 6th Floor
PO Box 090
Trenton, NJ 08625
609-292-4605
Fax: 609-984-3812
Southern Regional Office
5 Executive Campus, Suite 107
Cherry Hill, NJ 08034
856-486-4080
Fax: 856-486-2255
South Shore Regional Office
1325 Boardwalk, 1st Floor
Tennessee Ave & Boardwalk
Atlantic City, NJ 08401
609-441-3100
LANGUAGE ASSISTANCE SERVICES are available to you at ADH free of charge. To obtain services, call 844-932-6675.
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Eff: June 7, 2022
Gluten is the protein part of wheat, rye, barley, and other related grains. Some people cannot tolerate gluten when it comes in contact with the small intestine. This condition is known as celiac disease. In patients with gluten sensitivity or celiac disease, gluten injures the lining of the small intestine. This injury can result in weight loss, bloating, diarrhea, gas, abdominal cramps, and/or vitamin and mineral deficiencies. When patients totally eliminate gluten from their diet, the lining of the intestine has a chance to heal, and their symptoms improve as a result. Removing gluten from the diet is not easy. There are many gluten-free alternatives available.
| Food Group | Do Not Contain Gluten | May Contain Gluten | Do Contain Gluten |
|---|---|---|---|
| Thickening agents | Gelatin, arrowroot starch, corn flour, germ or bran, potato flour, potato starch flour, rice bran and flour, rice polish, soy flour, tapioca, sago | None | Wheat starch, all flours containing wheat, oats, rye, malt, barley, or graham flour, all-purpose flour, white flour, wheat flour, bran, cracker meal, durham flour, wheat germ |
| Condiments | Gluten-free soy sauce, distilled white vinegar, olives, pickles, relish, ketchup | Flavoring syrups (for pancakes or ice cream), mayonnaise, horseradish, salad dressings, tomato sauces, meat sauce, mustards, taco sauce, soy cause, chip dips) | None |
| Seasonings | Salt, pepper, herbs, flavored extracts, food coloring, cloves, ginger, nutmeg, cinnamon, bicarbonate of soda, baking powder, cream of tartar, monosodium glutamate | Curry powder, seasoning mixes, meat extracts | Synthetic pepper, brewer’s yeast (unless prepared with a sugar molasses base), year extract (contains barley) |
| Prescription Products | None | All medicines, check with pharmacist or pharmaceutical company | None |
| Meat or meat substitutes | 100% meats (no grain additives), seafood, poultry (breaded with pure cornmeal, potato flour or rice flour), peanut butter, eggs, dried beans or peas, pork | Meat patties, canned meat, sausages, cold cuts, bologna, hot dogs, stew, hamburger, chili, commercial omelets, soufflés, fondue, soy protein meat substitutes | Croquettes, breaded fish, chicken loaves made with bread or breadcrumbs, breaded or floured meats, meatloaf, meatballs, pizza, ravioli, any meat or meat substitute. Rye, barley, oats, gluten stabilizers |
| Breads & grains | Cream or rice, cornmeal, hominy, rice or wild rice, gluten-free noodles, rice wafers, pure corn tortillas, specially prepares breads, made with corn rice, potato, soybean, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa flour | Packaged rice mixes, ready-to-eat cereals containing malt flavorings, cornbread | Wheat, barley, rye |
| Fats & oils | Butter, margarine, vegetable oil, shortening, lard | Salad dressings, non-dairy creamers, mayonnaise | Gravy and cream sauces thickened with flour |
| Fruits | Plain, fresh, frozen, canned or dried fruit, all fruit juices | Pie fillings, thickened or prepared fruit, fruit fillings | None |
| Vegetables | Fresh, frozen or canned vegetables, white and sweet potatoes, yams | Vegetables with sauces, commercially prepared vegetables and salads, canned baked beans, pickles, marinated vegetables, commercially seasoned vegetables | Creamed or breaded vegetables, those prepared with wheat, rye, oats, barley, or gluten stabilizers |
| Snacks & Desserts | Brown and white sugar, rennet, fruit whips, gelatin, jelly, jam, honey, molasses, pure cocoa, fruit ice, carob | Custards, puddings, ice cream, ices, sherbet, pie fillings, candies, chocolate, chewing gum, cocoa, potato chips, popcorn | Cakes, cookies, doughnuts, pastries, dumplings, ice cream cones, pies, prepared cake and cookie mixes, pretzels, bread pudding |
| Beverages | Tea, carbonated beverages (except root beer), fruit juices, mineral and carbonated waters, wines, instant or ground coffee | Cocoa mixes, root beer, chocolate drinks, nutritional supplements, beverage mixes | Postum, ‘Ovaltine’, malt-containing drinks, cocomalt, beer, ale |
| Soups | Those made with allowed ingredients | Commercially prepared soups, broths, soup mixes, bouillon cubes | Soups thickened with wheat flour or gluten-containing grains, soup containing barley, pasta, or noodles |
About
Our GI Care
For Your Visit
Rockville Centre – Main Office
P: 516-593-4451
F: 833-450-4870
2000 N Village Ave., Suite #411
Rockville Centre, NY 11570
Mon: 9:00AM – 5:00PM
Tue: 9:00AM – 6:00PM
Wed: 9:00AM – 5:00PM
Thurs: 9:00AM – 6:00PM
Fri: 9:00AM- 5:00PM
Sat & Sun: Closed
Freeport
P: 516-593-4451
F: 833-450-4870
33 N Ocean Ave., 2nd Floor
Freeport, NY 11520
Mon: 9:00AM – 5:00PM
Tue: 9:00AM – 6:00PM
Wed: 9:00AM – 5:00PM
Thurs: 9:00AM – 6:00PM
Fri: 9:00AM- 5:00PM
Sat & Sun: Closed
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