Balance Billing
The Guthrie Clinic participates with many different insurance companies. For a complete listing please 点击这里
You may NOT be balanced billed for services, 世界博彩公司十大排名在某些情况下不参加你的保险计划. Non-Guthrie employed providers, are also NOT allowed to balance bill, 如果他们在某些情况下也不参加你的保险计划. For a list of non-Guthrie employed providers, please review the Guthrie Financial Assistance policy. It’s important to understand your rights and responsibilities. Please review “Your Rights” document. What are the new protections? | CMS
Your Rights and Protections Against Surprise Medical Bills
当您在网络内医院或流动外科中心接受紧急护理或由网络外提供者治疗时, you are protected from balance billing. 在这些情况下, you shouldn’t be charged more than your plan’s copayments, 共同保险 and/或扣除.
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, like a copayment, 共同保险, 或扣除. 如果你去看医疗服务提供者或访问不在你的健康计划网络内的医疗机构，你可能会有额外的费用或必须支付全部账单.
“网络外”指的是没有与你的健康计划签订合同来提供服务的供应商和机构. 网络外的供应商可能会被允许向你收取你的计划支付和服务全额收费之间的差额. This is called “balance billing.这个金额可能比网络内相同服务的费用要高，而且可能不计入你的计划的免赔额或年度自付限额.
“Surprise billing” is an unexpected balance bill. 当您无法控制谁参与您的护理时，可能会发生这种情况-例如当您遇到紧急情况时，或者当您计划在网络内设施就诊但意外地由网络外提供者治疗时. 出人意料的医疗账单可能会花费数千美元，这取决于手术或服务.
What is Provider-Based Status?
基于提供者的地位是医疗保险对医院和诊所认可的地位. 它是综合医疗保健服务系统(如Guthrie Lourdes)的全国实践模式，包括医院和医生办公室. 换句话说，这意味着医生办公室是医院的部门. 拥有提供者身份的好处之一是有机会参加联邦340B药品采购计划.
Will I have to pay an additional fee for my next visit?
根据不同的保险，患者可能会经历共同支付或共同保险责任的变化. This change will 不 impact patients covered by Medicaid. 病人将继续收到在世界博彩公司十大排名卢尔德医院接受治疗的账单, 但收费将分为从医院获得的服务和从提供者获得的服务. 这与世界博彩公司十大排名·卢尔德目前为急诊室等其他医院服务收费的方式没有什么不同, Therapy 服务, Lab services and surgical procedures.
你 protected from balance billing for:
Emergency services
如果您有紧急医疗状况，并从网络外的提供商或设施获得紧急服务, 他们最多只能向你收取你的医保网内费用分摊额(比如共付额), 共同保险, and deductibles). You 不能 be balance billed for these emergency services. This includes services you may get after you’re in stable condition, 除非你书面同意并放弃你的保护，否则不要为这些后稳定服务买单. If your insurance ID card says “fully insured coverage,” you 不能 给予书面同意，放弃你的保护，不平衡结算后稳定服务.
纽约州的意外医疗账单的简单语言信息可在 Surprise Medical Bills | Department of Financial 服务 (ny.gov) 宾夕法尼亚州在余额账单明文要求方面的信息有限.
Certain services at an in-network hospital or ambulatory surgical center
当你从网络内医院或流动外科中心获得服务时, certain providers there may be out-of-network. 在这种情况下，这些供应商最多只能向你收取你计划的网络内费用分摊额. This applies to emergency medicine, 麻醉, 病理, 放射学, 实验室, 新生儿学, assistant surgeon, hospitalist, or intensivist services. 这些供应商不能平衡你的账单，可能不会要求你放弃你的保护不平衡账单.
If you get other types of services at these in-network facilities, out-of-network providers 不能 balance bill you, unless you give written consent and give up your protections. If your insurance ID card says “fully insured coverage,” you 不能 如果他们是一个意外的法案，放弃你对这些其他服务的保护. 意外账单是当你在网络内的医院或流动外科机构，而参与的医生不在的时候, a non-participating doctor provided services without your knowledge, or unforeseen medical services were provided.
服务 referred by your in-network doctor
If your insurance ID card says “fully insured coverage,意外费用包括你的网络内医生未经你同意将你转介给网络外的医生(包括实验室和病理服务)。. These providers 不能 balance bill you and may 不 ask you to give up your protections 不 to be balance billed. 您可能需要签署一份表格(可在金融服务部的 网站) for the full balance billing protection to apply.
你 从来没有 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.
纽约州的意外医疗账单的简单语言信息可在 Surprise Medical Bills | Department of Financial 服务 (ny.gov) 宾夕法尼亚州在余额账单明文要求方面的信息有限.
When balance billing isn’t allowed, you also have these protections:
- 你只负责支付你的那部分费用(比如共同支付), 共同保险, 如果提供者或设施在网络内，你需要支付的免赔额). 您的健康计划将直接向网络外的供应商和机构支付任何额外费用.
- Generally, your health plan must:
- 承保紧急服务，而无需事先获得服务批准(也称为“事先授权”).
- Cover emergency services by out-of-network providers.
- 将你欠供应商或机构的费用(费用分摊)建立在支付给网络内供应商或机构的费用基础上，并在你的利益解释中显示该金额.
- 将您支付的紧急服务或网络外服务的任何金额计入您的网络内免赔额和自付限额.
If you think you’ve been wrongly billed, please contact Guthrie’s billing office at 570-887-2600. 联邦信息和投诉电话号码是:1-800-985-3059.
访问 No Surprises Act | CMS for more information about your rights under federal law.
纽约州的意外医疗账单的简单语言信息可在 Surprise Medical Bills | Department of Financial 服务 (ny.gov) 宾夕法尼亚州在余额账单明文要求方面的信息有限.