Category Archives: Practice News

The No Surprise Act Explained

Your Rights and Protections Against Surprise Medical Bills
When you receive emergency care or are 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.

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, 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 is not in your health plan’s network.

“Out-of-network” describes providers and facilities that have not 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 cannot control who is involved in your care—similar to 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.

You are protected from balance billing for:

Emergency Services: If you have an emergency medical condition and receive 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 cannot be balance billed for these emergency services. This includes services you may receive after you are 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 receive 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 cannot balance bill you and may not ask you to give up your protections.

If you receive other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.

You are never required to give up your protections from balance billing. You also are not required to receive care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

Your health plan generally must:
• Cover emergency services without requiring you to obtain approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you have been wrongly billed, you may contact the No Surprises Help Desk at 1-800-985-3059.

Visit https://www.cms.gov/nosurprises or https://youtu.be/eKJscqVwYls for more information about your rights under federal law.

Face Covering Required

Dear Patients and Families, Due to the continued increase in the amount of COVID-19 cases in our area, our practice has decided to implement a new policy regarding face coverings.  Effective immediately, face coverings are REQUIRED in order to enter either of our locations. This requirement is for anyone entering our offices over the age of 2. We… Continue Reading

We Are Here For You

Dear Patients and Families, We know your life, and the lives of your loved ones, have been affected by the COVID-19 outbreak. During this time, it is more crucial than ever that you can take care of yourself and your family. Our practice has one simple message: We are still here for you. We want… Continue Reading

Telehealth Appointments are Available

We hope that you and your loved ones are staying safe during this stressful time. We want to reassure you that we open and here for you during this pandemic. Your health and safety are our priority. We remain open from 8 am – 4:45 pm with a modified schedule at both of our locations and Saturday’s from 10 am  – 11:45… Continue Reading

Novel Coronavirus (COVID19) Letter to Patients

March 16, 2020 COVID-19 update Dear Patients and Families, Wake Forest Pediatrics is taking the new Coronavirus threat seriously. We are working closely with local health officials and hospitals to put into place mechanisms to keep our community as safe as possible. The most effective approach to contain the spread of this virus is through… Continue Reading

WFPA, PLLC Quality Measurement and Improvement

Wake Forest Pediatric Associates, PLLC is dedicated to providing high quality patient services and care.  Throughout the year we look at services and treatment provided at the office and look for opportunities to make improvements.  The link below outlines the quality improvement measures and outcomes for 2016. NCQA PCMH 2014 Quality Measurement and Improvement Worksheet Continue Reading

Lori Stiegemeier, DO Joins the Practice

Join us as we welcome Lori Stiegemeier, DO to the practice. “Dr. Lori” will work in the Knightdale location on Monday, Wednesday, Thursday, and Friday Dr. Stiegemeier was born and raised in Chapel Hill, NC (Go heels!). She received her undergraduate degree in Biology and Psychology from the University of North Carolina at Chapel Hill… Continue Reading

Amber Dodgen, MD Joins the Practice

Please join us in welcoming Amber Dodgen, MD to Wake Forest Pediatric Associates. Dr. Dodgen works Monday, Wednesday and Friday in our Knightdale location. Dr. Dodgen was born in Huntington, West Virginia and moved to Northeast Georgia at the age of 8. She grew up in the small town of Maysville, Georgia. Dr. Dodgen completed… Continue Reading

National Asthma Awareness Day – May 5

Our office will be hosting an Asthma Awareness event on May 5th from 1:30pm – 3:30pm at our Wake Forest location.  Please stop by the office to learn more about asthma triggers & management, enjoy a Kona ice, meet Buster from PBS, register to win prizes and talk with Barbara Gwinn, RN, CertifiedAsthma Educator or… Continue Reading

Christine Wu, MD Joins the Practice

Please join us in welcoming Christine Wu, MD to Wake Forest Pediatric Associates. Dr. Wu will be working Mondays and Tuesdays in our Knightdale location beginning this spring.. Prior to joining our practice she worked as a pediatrician in Cleveland, OH and Raleigh, NC. Dr. Wu is a Board Certified Pediatrician and Fellow of the… Continue Reading

patient portal