No Surprises Act Policy

Overview

When you get emergency care or are treated by an out-of-network provider at an in-network facility, you are protected from surprise billing — also known as balance billing. As a pediatric primary care practice, PHCA bills transparently and works with your insurance to minimize unexpected costs.

Your Rights Under the Law

You are protected from balance billing for:

• Emergency services, including services you may get after you're in stable condition, unless you give written consent and give up your protections
• Certain services at an in-network hospital or ambulatory surgical center, where you may be treated by out-of-network providers without your knowledge

When these protections apply, you only pay your normal cost-sharing amount (copayments, coinsurance and deductibles that you would pay if the provider were in-network).

Good Faith Estimates

If you don't have insurance, or you choose not to use your insurance for a visit, PHCA will provide a Good Faith Estimate of expected charges before your scheduled service, upon request or when scheduling care.

Balance Billing

"Balance billing" is when an out-of-network provider bills you for the difference between their charge and the amount your insurance plan agrees to pay. PHCA does not balance-bill patients in situations covered by the No Surprises Act, and we will always inform you in advance if a service may involve an out-of-network provider.

Payment Disputes

If you believe you've been wrongly billed, contact our billing office first — most issues are resolved quickly. You may also contact the No Surprises Help Desk at 1-800-985-3059 or visit cms.gov/nosurprises for more information about your rights.

Contact Us

Questions about a bill or this policy? Contact our billing team at (814) 944-7383 or phca5@yahoo.com.