Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under state and federal law, a patient may ask a health care provider or facility for a Good Faith Estimate of the price they will be charged for nonemergency health care, including costs such as medical tests, prescription drugs, equipment, and hospital fees. The Good Faith Estimate will be in writing and provided within the timeframes stated below:
Any patient may request a Good Faith Estimate of expected charges for nonemergency health care services. When requested, you will receive a copy of this Good Faith Estimate within 3 business days of the request (when uninsured or self-pay) and 5 business days (when insured).
Uninsured Patients. Federal law requires health care providers to provide a Good Faith Estimate in advance of scheduling or upon request if you are uninsured or self-pay (not using your insurance to pay for the item or service). Good Faith Estimates will be provided within 3 business days of scheduling nonemergency health care services or within 1 business day if nonemergency health care services are scheduled to be performed within 3 business days.
You may ask for a Good Faith Estimate before scheduling an item or service. Uninsured or self-pay patients may dispute the actual charges if they exceed the Good Faith Estimate by at least $400.00.
For questions about the Good Faith Estimate, visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059.
No Surprise Medical Bills
When you get emergency care or are 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 “surprise billing” or “balance billing”)?
When you see a health care provider, you may owe certain out-of-pocket costs, such as a copay, coinsurance, and/or deductible. You may owe the entire bill if you see a provider or visit a facility that is not 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 agrees to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely to cost you more money than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected bill. This may happen when you cannot select 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.
Protection from Balance Billing for Emergency Services and 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. 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 cannot balance bill you and may not seek your consent to be balance billed.
If you get other services at these in-network facilities, out-of-network providers cannot balance bill you unless you give written consent and give up your protections. An out-of-network provider must give notice at least 5 business days before the services are scheduled to be provided, and include a notice summarizing your balance billing rights, including a good faith estimate of the charges for such services. The provider is obligated to explain any charges that exceed the good faith estimate.
You are 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 (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 must:
Cover emergency services without requiring you to get approval in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility 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 the Indiana Department of Insurance by calling (317) 232-8582 or visit their website (https://www.in.gov./idoi) for more information about Indiana’s balancing billing laws.
Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.