(763) 498 1822

Good Faith Estimate You have the Right to Receive a Good Faith Estimate of Expected Charges under the No Surprises Act when using Out-of-Network insurance or paying out-of-pocket. This will be created prior to your intake session or first meeting using these options for payment along with you signing an informed consent. You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost 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. Make sure your health care provider gives you a copy of your Good Faith Estimate at least 1 business day before your medical service. You can also ask your provider for a Good Faith Estimate before you schedule a service. If you receive a bill that is $400 or more than your Good Faith Estimate, you have the right to dispute the bill. Make sure to save a copy of your Good Faith Estimate for reference. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises. “Balance Billing” When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network (out-of-network). “Out-of-Network” describes providers and facilities that haven’t contracted with your health plan. Out-of-Network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit or deductible. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network. You are responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan can pay out-of-network providers and facilities directly. If you believe you’ve been wrongly billed, you may contact your Provider or reach information for consumers at: https://www.cms.gov/nosurprises/consumers.