No Surprises Act

A ruling called the No Surprises Act went into effect on January 1, 2022, requiring healthcare providers to provide a Good Faith Estimate (GFE) for out-of-network care.

Your Right to a Good Faith Estimate

Under Section 2799B-6 of the Public Health Service Act (PHSA), healthcare providers and facilities must inform individuals who:

• Are not enrolled in an insurance plan or a federal health care program

• Are not seeking to file a claim with their insurance

that they are entitled to receive a Good Faith Estimate of expected charges before receiving services. This estimate must be provided both orally and in writing upon request or before scheduling care.

Good Faith Estimate Disclaimer

• This estimate outlines the expected costs for your treatment based on information available at the time it was created.

• It does not include unforeseen costs that may arise due to complications or special circumstances.

• If unexpected expenses occur, you may be charged more than the estimate.

Your Rights if You Receive a Bill Higher than the Good Faith Estimate

If your final bill is substantially higher than your Good Faith Estimate, you have the right to dispute the charges.

You can:

1. Contact the provider or facility listed on the estimate to discuss discrepancies.

2. Request an updated bill that matches the Good Faith Estimate.

3. Ask about financial assistance or negotiate the bill.

4. Initiate a formal dispute resolution process with the U.S. Department of Health and Human Services (HHS).

How to Dispute a Higher Bill

• You must file a dispute within 120 calendar days (about 4 months) of receiving the original bill.

• There is a $25 fee to initiate the dispute process.

• If the reviewing agency agrees with you, you only pay the amount listed on the Good Faith Estimate.

• If the agency agrees with the provider, you must pay the higher amount.

To start the dispute process and access the required forms, visit www.cms.gov/nosurprises or call 800-985-3059.

For more information about your rights to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.