Rates and Insurance

Effective January 1, 2022, the No Surprises Act (NSA) protects uninsured (or self-pay) individuals from many unexpectedly high medical bills.

If you’re without health insurance or plan to cover your healthcare expenses independently, it’s standard for healthcare providers and facilities to provide you with an expected cost estimate when scheduling an appointment for a healthcare service or item, or upon your request. This is referred to as a “good faith estimate.”

It’s important to note that a good faith estimate is not a bill. It provides an overview of the anticipated charges for services or items from your provider or facility. As this estimate is formulated based on available information at the time of its creation, it may not encompass unforeseen or undisclosed costs that could arise during your treatment.

In general, the good faith estimate should cover:

• The main service or item
• Any additional services or items reasonably expected to be part of the main service or item during the period of care.

However, it might not incorporate every service or item from other providers or facilities, even if these services appear linked to the same treatment. For instance, if you’re undergoing surgery, the estimate might encompass the surgery costs, anesthesia, laboratory services, or tests. Yet, certain scheduled services related to the surgery, like pre-surgery appointments or post-surgery physical therapy, might not be included in the initial estimate. In such cases, you’d receive a separate good faith estimate upon scheduling these specific services or by requesting it.

Your entitlement to a good faith estimate is protected by certain guidelines:

• Providers or facilities must provide the estimate after you’ve scheduled a healthcare service or item. If you schedule the service at least 3 business days before the appointed date, you should receive the estimate no later than 1 business day after scheduling. Alternatively, if you schedule or inquire about cost information at least 10 business days before the service date, you should receive the estimate no later than 3 business days after scheduling or inquiry.
• The estimate must detail each service or item (associated with the provider or facility) with specific information like the healthcare service code.
• It should be presented in an accessible format, such as large print, Braille, audio files, or other communication forms that suit your needs.

Providers and facilities are obligated to explain the estimate verbally or in person if requested, followed by a written (paper or electronic) estimate according to your preferred communication method.

It’s advisable to retain the estimate for future reference in case you receive bills later on. If the billed amount surpasses the good faith estimate by $400 or more, you might be eligible to dispute the bill.

If you would like more information on the No Surprise Act or need to file a dispute use the link or phone number below for more information.

https://go.cms.gov/45USoUy or call 800-985-3059