Balance billing happens when an out-of-network provider charges more than the in-network rate.
Balance billing can result in significant, unexpected bills, because PEHP has no pricing agreements with out-of-network providers. Unless you have made previous arrangements, they are under no obligation to bill within a certain amount. Nothing you pay for balance billing counts toward your deductible or out-of-pocket maximum.
How can you avoid balance billing? First, make sure make sure every person and every facility involved in your care is in your medical or dental network. Find in network providers at PEHP for Members (click “Find and Select a Provider” under the "my Benefits" menu).
If you can’t avoid seeing an out-of-network provider, consider negotiating a price beforehand. It can help to know the in-network fee, which you can find using the cost tools available at PEHP for Members.
Request to have a provider added to your network by filling out this form.