Provider Manual

PROHIBITION OF BALANCE BILLING

Network providers agree that in no event, including, but not limited to, non-payment by Carelon or payor, insolvency of Carelon or payor, or breach of the provider/facility agreement with Carelon, shall the provider bill, charge, collect a deposit from, seek remuneration or reimbursement from, or have any recourse against a member, for health care services provided pursuant to this agreement.

Providers may not bill members for services to be paid for by Carelon or for non-authorized services. This practice is known as “balance-billing.” Network providers who knowingly “balance bill” members are subject to provider sanctions. The network provider also agrees that this provision supersedes any oral or written contrary agreement previously entered into between the provider and member.

Co-payments and/or deductibles are not applicable to the Pennsylvania HealthChoices Medicaid population.