In an effort to protect individuals who are covered under group and individual health plans from receiving “surprise” medical bills from out-of-network providers at in-network facilities, the No Surprises Act was put into effect on January 1, 2022, with the intention of providing transparency to patients regarding medical billing. Healthcare providers, including dental providers at private practices, must now offer both uninsured and self-pay patients a good faith estimate for the cost of their care. Providers and healthcare facilities must provide these estimates in writing within 1-3 days from the day the patient schedules a service or requests an estimate.
The good faith estimate must include the following: (1) the anticipated charges of the requested service or item, and (2) an estimate of the charges that are reasonably expected to be provided in addition to the requested service or item. In the event the patient’s medical bill exceeds the good faith estimate by at least $400.00 (or more), the patient may begin the newly established dispute resolution process (such as negotiation, mediation or arbitration) within 120 days from the date of the medical bill.
The good faith estimates requirements do not apply to individuals who participate in coverage through Medicare, Medicaid, the Indian Health Service, Veterans Affairs Health Care or TRICARE, as these programs currently offer similar protections to prevent surprise billing.
If you have concerns about whether you are in compliance with the requirements set forth in the No Surprises Act, or if you need assistance ensuring that you are in compliance with the Act, please contact us at info@martilawgroup.com or (860) 552-7770.