No Surprises Act

What are surprise medical bills?

If you have health insurance and get care from an out-of-network provider, your health plan may not cover the entire out-of-network cost. In the past, in addition to any out-of-network cost-sharing you might owe (like coinsurance or copayments), the out-of-network provider could bill you for the difference between the billed charge and the amount your health plan paid. This is called “balance billing” or “surprise billing” as it is an unexpected balance bill.

Will I receive a Surprise Medical Bill or be balance-billed by Personalis?

No, you will not receive a surprise medical bill nor be balance-billed. We will try to inform you of any estimated financial responsibility at the beginning of the testing process. You will only be financially responsible for any amount that your health insurance company may apply as a copay, co-insurance, or deductible. We will apply your in-network benefits to your out-of-pocket costs.

What is an out-of-network provider?

Out-of-network providers have not signed a contract with your health plan and may be permitted to bill you for the difference between what they charged and what your health plan agreed to pay. You may visit an in-network facility but can be unexpectedly treated by an out-of-network provider.

What if I don’t have health insurance?

If you don’t have health insurance, you can receive a good faith estimate of how much your care will cost before your test is processed. We will reach out to you when your test is ordered, to provide an estimate of your potential financial responsibility. Our NeXT Access financial assistance program may allow us to reduce or eliminate any out-of-pocket cost to you.

No balance billing for non-emergency services performed at certain participating healthcare facilities.

You are protected from balance billing by Personalis. There is no balance billing for non-emergency services performed at certain participating healthcare facilities without consent. Personalis is considered to be a non-emergent provider. You will not be charged for non-emergent services without your written consent. The most the provider may bill you is your plan’s in-network cost-sharing amount. You can’t be charged more than the in-network cost-sharing for these services and any cost-sharing you pay counts towards your deductible and maximum out-of-pocket limits for the policy year.

When balance billing isn’t allowed, you also have the following protections:

You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in‑network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact HHS at (800) 985-3059. Visit: https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law. Visit: https://www.insurance.ca.gov/01-consumers/101-help/ for more information about your rights under California state law.

Personalis Contact Information

For more information, please contact Patient Billing Services at (855) 373-7974 or billing@personalis.com.

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