Federal Surprise Billing Act of 2022
Your Rights and Protections against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
What is “balance billing”?
When you see a doctor or other health care provider, you may owe certain out-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have additional costs or have to pay the entire bill of you see a provider or visit a health care facility that isn’t in your health plan’s network.
You’re never required to give up your protections from balance billing. You’re not required to get out-of-network care and have the right to choose a provider or facility in your plan’s network.
Good Faith Estimate
Health care providers are required to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care services before they are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such services. This includes related costs like medical test, prescription drugs, equipment, and hospital fees.
- If you schedule a service at least 3 days in advance, you should receive a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care service at least 10 days in advance, you should receive a Good Faith Estimate in writing within 3 business days after scheduling.
- You can request a Good Faith Estimate prior to scheduling a services and should receive your Good Faith Estimate in writing within 3 business days.
- if you receive a bill that is more than $400 over your Good Faith Estimate from that provider of facility, you can dispute the bill.
For questions or more information about your rights to a Good Faith Estimate, visit www.cms.gov/nosurprises
Our practice is to collect all known fees upon registration – including deductibles, co-payments and co-insurance – based on your estimated charges. Your final billed will reflect actual charges for services provides, which may be higher or lower than any estimate provided.
If actual charges are higher than estimated, we may ask for additional payment. If actual charges are lower than estimated, we will process the appropriate refund.
Payment by Insurance or Other Coverage
If you have insurance or other coverage, we will bill your insurance company or other coverage shortly after your visit. Your insurance company or other coverage may contact you for additional information to process your claim. Please respond quickly to ensure you receive the maximum benefit from your coverage.
After the insurance or other coverage payment has been receives, you will receive a final billing statement from Palo Pinto General Hospital. The remaining balance may include deductibles, co-insurance, co-payments and any non-covered charges. If you have questions regarding the way your claim was process, please contact your insurance company or other coverage directly.
Payment is due upon receipt of the final billing statement. If payment in full is not possible, Palo Pinto General Hospital has payment options. Please see your final billed statement for online resources, or you may contact Med Cycle 888-642-2354 from 8 a.m. to 4:30 p.m., Monday through Friday, to discuss payment options.
Payment without Insurance of Other Coverage
Palo Pinto General Hospital has partners with MDSAVE to offer bundled pricing for services for patients without insurance or other coverage, or that choose not to sue their insurance or other coverage.
If payment in full is not possible, we will work with you to find an option that fits your needs. To discuss options such as obtaining coverage, applying for Medicaid or other financial assistance contact Financial Services 940-328-6253 from 8 a.m. through 4:30 p.m., Monday through Friday.
Your hospital bill contains charges for hospital services only. Certain professional and physician services are often performed along with hospital services as ordered by your treating physicians. You will be billed separately for physician services such as:
- Emergency room physicians
- Radiologists (physicians who interpret X-rays, MRI, CT, ultrasound)
- Pathologists (physicians who examine body tissues and body fluids reads)
- Cardiologists (physicians who treat heart and blood vessel conditions)
- Neonatologists (physicians who treat newborns in the neonatal intensive care unit)
- Anesthesiologists (physicians who administer general/regional anesthesia and pain management)
- Other consulting physicians
These are independent from the hospital and bill separately for their services.
Palo Pinto General Hospital cannot ensure physicians are contracted providers with your plan. Questions about these bills should be directed to the physician office.
Palo Pinto General Hospital does not automatically sent itemized statements. You may obtain an itemized statement via your MyConnect Patient Portal or you may contact Med Cycle at 866-642-2354 8 a.m. to 4:30 p.m., Monday through Friday.
If you have questions about your bill, or believe that it is incorrect, call Med Cycle at 888-642-2354 from 8 a.m. to 4:30 p.m., Monday through Friday.
A co-payment is a set fee the member pays to providers at the time services are provided. Co-pays are applied to emergency room visits, hospital admissions, office visits, etc. The cost is usually minimal. The patient should be aware of the co-payment amounts prior to services being rendered.
Deductibles are provisions that require the patient to accumulate a specific amount of medical bills before benefits are provided. For example, if a patient’s policy contains a $1000 deductible, the patient must accumulate and pay $1000 out of pocket before the insurance or other coverage plan will pay benefits. Contact your insurance or other coverage plan for information about your deductible.
Co-insurance is a form of cost sharing. After your deductible has been met, the plan will begin paying a percentage of your bills. The remaining amount, known as co-insurance, is the portion due by the patient.