; (B) acknowledges that the participant, beneficiary, or enrollee has been— (i) provided with a written estimate and an oral explanation of the charge that the participant, beneficiary, or enrollee will be assessed for the items or services anticipated to be furnished to the participant, beneficiary, or enrollee by such provider or facility; and (ii) informed that the payment of such charge by the participant, beneficiary, or enrollee may not accrue toward meeting any limitation that the health plan places on cost-sharing; and (C) documents the consent of the participant, beneficiary, or enrollee to— (i) be furnished with such items or services by such provider or facility