Rates and Policies

You have the right to receive a “Good Faith Estimate” of the expected cost of any non-emergency items or services. If you are eligible for a Good Faith Estimate, make sure your healthcare provider gives you one in writing at least one business day before you are to receive the medical service or item, unless your appointment is scheduled less than three days in advance. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. Make sure to save a copy or picture of your Good Faith Estimate. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through the U.S. Department of Health & Human Services. There is a fee to dispute bills.

Who is NOT affected by these “surprise billing” rules?

• Patients whose insurance isn’t accepted by the facility at all, but who choose to schedule or receive non-emergency care and will be submitting a superbill to their insurance company for Out-Of-Network reimbursement.
• Patients whose entire non-emergency visit is in-network, meaning the facility and treating providers participate in their insurance coverage.

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 be required 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’re never required to give up your protection 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.

For questions or more information about your right to Good Faith Estimate, visit www.cms.gov/nosurprises for more information about your rights under federal law.