No Surprises Act of 2022
The No Surprises Act (H.R. 133), effective January 1st, 2022, requires that health care providers provide an estimate of the bill for any medical items or services, to clients or patients who do not have insurance or who are not using insurance.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. The Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
If you receive a bill that is more than $400 than your Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
Your health care provider must give you a Good Faith Estimate within the following time frame:
If the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling;
If the service is scheduled at least 10 business days before the appointment date, no later than three business days after the date of scheduling; or
If the uninsured or self-pay patient requests a good faith estimate (without scheduling the service), no later than three business days after the date of the request. A new good faith estimate must be provided, within the specified timeframes if the patient reschedules the requested item or service.
The Good Faith Estimate is not a contract and does not require you to obtain the items or services from this provider.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 800-985-3059.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.
Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount. If you have questions or concerns, please let me know.
For more information about your rights under California state law visit California Department of Managed Health Care at www.dmhc.ca.gov or California Department of Insurance at www.insurance.ca.gov.
“Good Faith Estimate” Form-to be completed in coordination with Dr. A. Robin Aylor or her designated representative.