Balance Billing

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你的服务账单可能不平衡, when Guthrie does not participate with your insurance plan in certain circumstances. 非世界博彩公司十大排名雇佣的供应商, 也不允许平衡账单, if they also do not participate with your insurance plan in certain circumstances. 非世界博彩公司十大排名雇佣供应商的列表，请查看世界博彩公司十大排名 财政援助政策. 了解你的权利和责任是很重要的. 请参阅“您的权利”文件. 新的保护措施是什么? | CMS

你对意外医疗账单的权利和保护

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, 您不会受到余额结算的保护. In these cases, 你被收取的费用不应该超过你计划的共付额, 共同保险和/或免赔额.

什么是“余额账单”(有时称为“意外账单”)?

当你去看医生或其他医疗保健提供者时, 你可能需要支付一些自付费用, 比如共同支付, coinsurance, or deductible. You may have additional 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” 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. 这被称为“余额结算”.” 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.

“意外账单”是指意外的余额账单. 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 innetwork 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.

什么是基于提供者的状态?

Provider-Based Status is a status sanctioned by Medicare for hospitals and clinics. It is a national model of practice for integrated healthcare delivery systems such as Guthrie Lourdes that includes both hospital and physician offices. In other words, it means that physician offices are departments of the hospital. One of the benefits of having Provider-Based Status is the opportunity to participate in the Federal 340B Drug Purchasing Program.

我下次去需要额外付费吗?

Depending on insurance, patients may experience a change in co-pay or co-insurance responsibility. 这一变化不会影响医疗补助覆盖的患者.  Patients will continue to receive bills for the care they receive at Guthrie Lourdes, but charges will be separated to services received from the hospital and those received from providers. This is no different than the way Guthrie Lourdes currently bills for other hospital based services like the Emergency Department, 治疗服务, 实验室服务和外科手术.

您可以免受余额账单的保护:

紧急服务

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, 和免赔额). 你不能为这些紧急服务结清帐单. 这包括你在病情稳定后可能得到的服务, 除非你书面同意并放弃保护措施 not to be balanced billed for these post-stabilization services. 如果你的保险卡上写着"全保"你 can’t give written consent and give up your protections not to be balance billed for post-stabilization services.

New York State’s Surprise Medical Bills plain language information is available at 出人意料的医疗账单|美国金融服务部(Department of Financial Services.gov) and Pennsylvania has limited information in balance billing plain language requirements.

网络内医院或流动外科中心的某些服务

When you get services from an in-network hospital or ambulatory surgical center, 某些提供商可能不在网络中. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. 这适用于急诊医学, anesthesia, pathology, radiology, laboratory, neonatology, 助理外科医生, hospitalist, 或者重症监护服务. 这些提供者 can’t 平衡你和我的账单 not ask you to give up your protections not to be balance billed.

如果您在这些网络内设施中获得其他类型的服务, 网络外的供应商不能平衡你的账单, 除非你书面同意并放弃保护措施. 如果你的保险卡上写着"全保"你 can’t give up your protections for these other services if they are a surprise bill. Surprise bills are when you’re at an in-network hospital or ambulatory surgical facility and a participating doctor was not available, 非参与医生在你不知情的情况下提供服务, 或者提供意外的医疗服务. 

您的网络内医生推荐的服务 

如果你的保险卡上写着"全保,” surprise bills include when your in-network doctor refers you to an out-of-network provider without your consent (including lab and pathology services). 这些提供者 can’t 平衡你和我的账单 not 要求你放弃你的保护以避免结余. You may need to sign a form (available on the Department of Financial Services’ website)，以获得全额结余帐单保障.   

You’re never 要求你放弃对余额账单的保护. 你也不需要获得网络外的医疗服务. 您可以在您的计划网络中选择供应商或机构.

New York State’s Surprise Medical Bills plain language information is available at 出人意料的医疗账单|美国金融服务部(Department of Financial Services.gov) and Pennsylvania has limited information in balance billing plain language requirements.

当不允许余额结算时，您还可以使用以下保护:

  • You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
  • 一般来说，您的健康计划必须:
    • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
    • 覆盖网络外供应商提供的紧急服务.
    • 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 in-network deductible and out-of-pocket limit.

如果你觉得你被冤枉了， 请致电570-887-2600与世界博彩公司十大排名的帐单办公室联系. The federal phone number for information and complaints is: 1-800-985-3059.

Visit 无意外法案| CMS 了解更多有关您在联邦法律下的权利.

New York State’s Surprise Medical Bills plain language information is available at 出人意料的医疗账单|美国金融服务部(Department of Financial Services.gov) and Pennsylvania has limited information in balance billing plain language requirements.