Good Faith Estimate
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GOOD FAITH ESTIMATE POLICY
Right to Receive a Good Faith Estimate of Expected Charges
Under the law, health care providers need to give patients who do not have insurance, who are not using insurance, or whom are out of network an estimate of the bill for medical items and services. In the case of the surgery center this will include the facility, surgeon, anesthesia (if applicable), and pathology (if applicable). This is referred to as the “No surprises Act”.
What Is a Surprise Bill?
Surprise billing occurs when patients unknowingly receive services from a provider or facility that are outside of their health plans’ network. Because these out-of-network providers do not have a negotiated rate with insurers, they accept the health plan’s payment as partial and bill the patient for the remaining amount or balance – creating a “surprise” balance bill.
What Does “In- or Out-of-Network” Mean?
An “Out-of-Network” provider or organization does not have an agreement with your insurance company. You will have to pay more for services because not agreement is in place.
An “In-Network” provider or organization does have an agreement with your insurance company. You will have to pay less for services because an agreement is in place.
At the time of the preauthorization call, the preauthorization staff will inform you if your insurance company is an out-of-network provider. The staff will inform you of any fiscal responsibility such as your deductible, and maximum out-of-pocket. A written copy of the bill will be offered to the patient at the time of the preauthorization call
Before you schedule an appointment, please contact your insurance to find out if the hospital and its providers are in your network. Ask your insurance about your fiscal responsibility such as your deductible, and maximum out-of-pocket.
What Is the No Surprises Act?
The No Surprises Act protects the uninsured, self-pay, and insured patients from unexpected billing costs from out-of-network providers or hospitals. The federal bill reads:
- Medical services may be given in the hospital by in-network providers as well as out-of-network providers. Out-of-network providers may send you a separate bill.
- Your hospital might be in-network with your insurance, but that does not mean every provider that treats you in that hospital is in-network.
- 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 facility fee, surgeon, anesthesia, and pathology fees.
- The estimate must be provided within one business day after scheduling (when the service is scheduled at least three business days in advance) or no later than three business days after scheduling (when the service is scheduled at least 10 business days in advance). For uninsured or self-pay patients, it must be provided within three business days after the consumer who has not yet scheduled requests a good faith estimate.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive 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 picture of your Good Faith Estimate.
Help Arguing Against a Surprise Bill
If you need help arguing against a surprise bill, reach out to the Superintendent of Insurance at www.osi.state.nm.us or call 1-855-4-ASK-OSI (1-855-427-5674). The Office of the Superintendent of Insurance enforces insurance laws in New Mexico. They protect insurance members, and discover, prosecute, and prevent fraud. You may additionally visit the CMS website at www.cms.gov/nosurprises or call 1-800-985-3059.
Medical Passports are secure, online patient-controlled accounts that provide medical history information.
Southern New Mexico Surgery Center offers an easy way for patients to pay your bill.
CareCredit is a healthcare credit card designed for your health and wellness needs for you, your entire family and your pets.
Southern New Mexico Surgery Center is a 2020 National APEX Quality Award Winner.