Received a bill from a hospital after a visit and not sure why? Don't panic — and don't pay it yet. Here's what's likely going on and what to do.
Why this happens
OS BENEFiTS PPO plans use Reference-Based Pricing (RBP) for hospital services. Instead of a traditional hospital network, your plan pays hospitals a fair, benchmarked price for care. This keeps premiums lower — but occasionally a hospital bills for more than the plan's benchmarked payment and sends the difference to you. This is called a balance bill.
A balance bill is not the same as your normal copay or coinsurance, and receiving one does not mean you did something wrong or that your care wasn't covered.
What to do if you receive a bill
Don't pay it yet. Balance bills are often negotiable, and in many cases you shouldn't owe the billed amount at all
Send it to us. Email a photo or copy of the bill to [email protected] along with the date of service
We'll take it from there. Our team will review the bill, work with the hospital on your behalf, and let you know exactly what (if anything) you actually owe
The sooner you send a bill over, the easier it is to resolve — so don't sit on it, even if it looks intimidating.
What you should expect to pay for hospital care
Your actual costs for hospital services are the copays, deductible, and coinsurance listed on your plan overview and SBC — for example, a set copay per admission or coinsurance after your deductible, depending on your plan. Anything a hospital bills beyond that is worth sending to us before you pay a cent.
Got a bill that doesn't look right?
Email: [email protected]
Call: (866) 486-8242
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