Getting cost estimates before you get an item or service if you’re uninsured or self-pay
Beginning January 1, 2022, if you’re uninsured or you pay for health care bills yourself (don’t have your claims submitted to your health plan), health care providers and facilities must provide you with an estimate of expected charges before you get an item or service. This is called a “good faith estimate.” Providers and facilities must provide you with a good faith estimate if you request one, or after you’ve scheduled an item or service. It should include expected charges for the primary item or service you’re getting, and any other items or services that are provided as part of the same scheduled experience.
Providers and facilities must:
- Provide the good faith estimate before an item or service is scheduled, within certain timeframes.
- Offer an itemized list of each item or service, grouped by the provider or facility offering care. Each item or service has to have specific details, like the health care code assigned to it and the expected charge.
- Explain the good faith estimate to you over the phone or in-person if you request it, and then follow up with a written (paper or electronic) estimate.
- Provide the good faith estimate in a way that’s accessible to you.
Once you receive a good faith estimate from your provider or facility, be sure to keep it in a safe place so you can compare it to any bills you get later. If you’ve had your service and find that the billed amount is at least $400 above the good faith estimate, you may be eligible to start a patient-provider dispute resolution process. Learn more about the dispute resolution process, including eligibility requirements and what information or documents you need to start a dispute.
Article from: https://www.cms.gov/nosurprises/consumers/understanding-costs-in-advance