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Pikeville Medical Center is committed to helping you understand your upcoming health care costs so you can plan for your care. The federal No Surprises Act went into effect on Jan. 1, 2022. The law’s intent is to help patients understand health care costs in advance of care and to minimize unforeseen — or surprise — medical bills.

 

No Surprises Act Overview

  • Patients are protected from receiving surprise medical bills resulting from out-of-network care for emergency services and for certain scheduled services without prior patient consent.
  • Patients who do not have insurance or who are not using insurance to pay for care have a right to receive a good faith estimate of their potential bill for medical services when scheduled at least three days in advance.
  • Individuals with Medicare, Medicare Advantage, Medicaid, Indian Health Services, VA health care, or TRICARE insurance plans are not covered under the No Surprises Act because these federal insurance programs have existing protections in place to minimize large, unforeseen bills

 

Surprise Medical Bills

 

Unforeseen medical bills can happen when a patient receives emergency or scheduled clinical care or services from a provider or facility that is considered out of network or non-participating by that patient’s insurance plan. These surprise bills are often called balance billing or out-of-network billing.

 

  • Balance billing occurs when a provider sends a bill to a patient to cover the difference between what the insurance plan agreed to pay the provider and the gross charges for your service. Learn more about your rights for balance billing.
    thumbnail of Your Rights and Protections Against Surprise Medical Bills

    Click the image above to learn about your rights and protections against Surprise Medical Bills.

  • Out-of-network costs happen when a patient receives care from a facility or provider that haven’t signed a contract with your health plan. This may result in a higher patient cost than if the patient were seen at an in-network provider or facility.

 

Similarly, patients are protected from receiving surprise bills for certain scheduled services for which they could not reasonably know the network status of a provider. For certain scheduled care with out-of-network providers, patients must be given appropriate notice and give approval, where applicable, to be billed for any applicable out-of-network fee or amount.

 

Get a Cost of Care Estimate

Uninsured and self-pay patients have a right to receive a good faith estimate ahead of scheduled nonemergency health care services. A good faith estimate shows the cost of items and services that are reasonably expected for your health care needs. The estimate is based on information known at the time the estimate was created, and can include costs related to your visit such as medical tests, medications, equipment and hospital fees.

thumbnail of You have the right to receive a Good Faith Estimate explaining how much .._

Click the image above to learn about your right to receive a Good Faith Estimate explaining how much your medical care will cost.

Health care providers should give you the estimate in writing at least one day before your medical service if your care has been scheduled at least three days in advance. You may also request an estimate at any time.

 

Do you need assistance paying your bill?

Pikeville Medical Center’s mission is to advance the health and well-being of our region through comprehensive care in a Christian environment.  We welcome all patients (regardless of insurance status) to contact us for information about our financial assistance programs or for a better understanding of their insurance coverage.

Please contact our patient financial counselor’s office at (606) 218-3510 if you have questions about charges for your upcoming hospital visit.

 

If you think you’ve been wrongly billed, contact the Centers for Medicare and Medicaid Services at (800) 985-3059.

 

Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.