If You Get a Bill or Statement

When Can a Provider Bill Me?

Providers may bill you if: 

• You did not pay your child’s copayment. 
• Your child received services from an out-of-network provider without approval from Keystone First – CHIP, the provider told you before your child received the service that the service would not be covered, and you agreed to pay for the service.
• You child received services that are not covered by Keystone First – CHIP, the provider told you before your child received the service that the service would not be covered, and you agreed to pay for the service.
• Your child received a service from a provider who is not enrolled with the Commonwealth.
• Your child goes over a benefit limit on a service.
• Your child received a medical service that is not a covered benefit.

Out-of-network providers are not allowed to bill Enrollees for services above and beyond Keystone First – CHIP’s agreed upon reimbursement rate. This means that, other than in the above circumstances, you should not receive a bill from an out-of-network provider. If you do receive a bill from an out-of-network provider, call Enrollee Services at 1-844-472-2447 (TTY 711) immediately so the situation can be resolved as soon as possible.

What Do I Do if I Get a Bill?

If you get a bill from a Keystone First – CHIP network provider and you think the provider should not have billed you, you can call Enrollee Services at 1-844-472-2447 (TTY 711). If you get a bill from a provider for one of the above reasons that a provider is allowed to bill you, you should pay the bill or call the provider.

To ask for payment for eligible medical care you have already received, please complete the Enrollee Reimbursement Medical Claim Form (PDF).