Your Rights and Protections Against Surprise Medical Bills

 

What is “balance billing” (sometimes referred to as “surprise billing”)?

 

When you see a doctor or other healthcare provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a healthcare 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.

 

If you knowingly choose an out-of-network provider for your care, it is not a surprise medical bill.

 

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.

 

Visit [www.cms.gov/nosurprises] or call 800-985-3059 for more information about your rights under federal law.

Visit [www.insurance.pa.gov/nosurprises] or call 877-881-6388 for more information about your rights under PA state law.

 

Right to Receive a Good Faith Estimate?

 

The Federal Register requires providers to furnish a good faith estimate that shows the costs of items and services that are reasonably expected for your healthcare needs.

 

The estimate is based on information known at the time the estimate is created. The Good Faith Estimate doesn’t include any unknown or unexpected costs that can arise during treatment. You could be charged more if complications or special circumstances arise. If this happens, federal law allows you to dispute (appeal) the bill. You can contact the healthcare provider to let them know the billed charges are higher than the Good Faith Estimate you received. You can:

• Ask them to update the bill to match the Good Faith Estimate

• Negotiate the bill

 

If you are billed for more than the Good Faith Estimate, you have the right to dispute the bill.

 

Per Federal law, you may dispute your bill if it’s at least $400 more than the estimate. You may contact the provider listed to let them know the billed charges are higher than the Good Faith Estimate and ask them to update the bill to match the GFE or negotiate the bill.

 

Contact the provider:

 

Phone: 814-944-9970

Mail:

Blair Family Solutions, LLC.

1310 Valley View Blvd

Altoona, PA 16602

 

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

 

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate. If the agency disagrees with you and agrees with the healthcare provider, you will have to pay the higher amount.

 

To learn more and get a form to start the process, go to http://www.cms.gov/nosurprises or call 800-985-3059.