No Surprises Act

Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a health plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage of their ability, upon request or at the time of scheduling health care items and services, for receipt both orally and in writing of a Good Faith Estimate of expected charges.

Important: These are estimates and final billing statements could include additional services deemed medically necessary.

Health Plan Price Transparency

Health plan price transparency helps consumers know the cost of a covered item or service before receiving care. Beginning July 1, 2022, most group health plans, and issuers of group or individual health insurance are required to post pricing information for covered items and services. This pricing information can be used by third parties, such as researchers and app developers to help consumers better understand the costs associated with their health care. More requirements will go into effect in 2024 which will provide additional access to pricing information and enhance consumers’ ability to shop for the health care that best meets their needs.

If you are covered by health insurance, we strongly encourage you to consult with your health insurer to determine accurate information about your financial responsibility for a health care service provided at NSMI. We are happy to provide patients with the CPT codes and descriptions of the requested service so they may look up the pricing with their insurance provider.

Below are the links to the patient portals for our most common insurance payors but we also encourage patients to use the contact information found on the back of your insurance card for the most accurate information.

Cigna
UnitedHealthcare
Aetna
AnthemBCBS
CareFirst
Medicare

Right to Receive Good Faith Estimate

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • 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 schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the healthcare provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
  • If you received a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or a picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.