If you get a bill or statement

As a Keystone First Member, you are not responsible to pay for medically necessary, covered services. 

Even if your Keystone First provider does not get a payment for the service, you are not responsible for the payment. However, you may have to pay a co-pay.

There are times when you can be billed for a health care service. You can be billed if:

  • You get a service that needed prior authorization, but Keystone First did not give prior authorization
  • You get a service from a provider who is not in the Keystone First network and prior authorization was not given to see that provider (except for emergency services; family planning services; and any Medicare-covered services from a Medicare provider if you have Medicare coverage)
  • You get a service that is not covered by Keystone First and your health care provider told you before you got the service that it would not be covered

Your health care provider can also bill you for co-pays that were not paid at the time you got the service.

If you receive a bill from a health care provider, you should call the health care provider listed on the bill to make sure they have all your insurance information. If you still feel you should not have been billed, you should call Keystone First Member Services.