Your Rights to a Good Faith Estimate
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
If you are uninsured or don’t intend using insurance to pay for scheduled non-emergency health care services, federal law requires that health care providers and facilities provide you with an estimate of the expected charges for medical items and services at least 1 business day before the scheduled services are to be performed. If the bill you receive is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Any patient may request an estimate of the expected charges for non-emergency health care services that have been ordered, scheduled, or referred and state law requires that health care providers and facilities provide you with an estimate of the expected bill for medical items and services within 5 business days of the request.
When obtaining an estimate, make sure to save a copy or take a picture of your Good Faith Estimate.
Contact our Financial Counselor at 502-681-1440 to request a good faith estimate.
For more information about your right to a Good Faith Estimate, visit Centers for Medicare & Medicaid Services (CMS) at: www.cms.gov/nosurprises/consumers or call 1-800-985-3059.
No Surprise Billing Notice
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balanced billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balance billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center.
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network providers. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
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 ro out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the Department of Health and Humans Services Center for Medicare and Medicaid Services by calling the No Surprises Helpdesk at 1-800-985-3059, or visiting http://www.cms.gov/nosurprises.
Visit http://www.cms.gov/nosurprises for more information about your rights under federal law.