PSA: PRC Referrals regarding Trinity Hospital
We want to keep our patients informed about an important change in our referral process.
𝐎𝐮𝐫 𝐜𝐥𝐢𝐧𝐢𝐜 𝐰𝐢𝐥𝐥 𝐛𝐞 𝐥𝐢𝐦𝐢𝐭𝐢𝐧𝐠 𝐨𝐮𝐫 𝐧𝐨𝐧-𝐞𝐦𝐞𝐫𝐠𝐞𝐧𝐭 𝐏𝐮𝐫𝐜𝐡𝐚𝐬𝐞𝐝/𝐑𝐞𝐟𝐞𝐫𝐫𝐞𝐝 𝐂𝐚𝐫𝐞 (𝐏𝐑𝐂) 𝐫𝐞𝐟𝐞𝐫𝐫𝐚𝐥𝐬 𝐭𝐨 𝐓𝐫𝐢𝐧𝐢𝐭𝐲 𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥.
Federal regulations—based on Subpart D and Section 506 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003—require Medicare‑participating hospitals to:
A). Participate in IHS‑funded PRC programs
B). Accept Medicare‑Like Rates (MLR) as payment in full
C). Not bill the patient for any remaining balance
Because Trinity is a Medicare‑participating hospital, they are required to follow these rules. Instead, they have been balance billing our patients, which violates federal protections for IHS beneficiaries. For this reason, we must limit our referrals during this time.
"𝐖𝐡𝐚𝐭 𝐈𝐬 𝐁𝐚𝐥𝐚𝐧𝐜𝐞 𝐁𝐢𝐥𝐥𝐢𝐧𝐠?"
Balance billing happens when a patient’s health insurance company pays an out-of-network physician or other health care provider less than the amount the physician charges for the care. Because the physician and the health plan have not agreed upon payment through a contract, the physician bills the patient for the remainder of the costs.
For Example: When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30.
In your case, you are protected by these federal regulations along with your PRC referral from this balance billing practice.
We are aware of the ongoing situation and are working diligently to get this issue resolved.
If you have a current or previous PRC referral to Trinity and receive any bills from Trinity Medical Group, please continue to turn them in to our PRC office right away. We will review them and ensure they are handled appropriately.
Our priority is to protect our patients and make sure you receive care from providers who follow federal law.
𝐈𝐟 𝐲𝐨𝐮 𝐡𝐚𝐯𝐞 𝐪𝐮𝐞𝐬𝐭𝐢𝐨𝐧𝐬 𝐚𝐛𝐨𝐮𝐭 𝐭𝐡𝐢𝐬 𝐜𝐡𝐚𝐧𝐠𝐞 𝐨𝐫 𝐲𝐨𝐮𝐫 𝐫𝐞𝐟𝐞𝐫𝐫𝐚𝐥 𝐨𝐩𝐭𝐢𝐨𝐧𝐬, 𝐨𝐮𝐫 𝐏𝐑𝐂 𝐭𝐞𝐚𝐦 𝐢𝐬 𝐡𝐞𝐫𝐞 𝐭𝐨 𝐬𝐮𝐩𝐩𝐨𝐫𝐭 𝐲𝐨𝐮. You can utilize our website contact form by clicking here, or call our department at 701-627-7368.
Elbowoods Memorial Health Center Purchased and Referred Care Team