No Surprises Act & Good Faith Estimates

For protected services, you pay only what you would normally pay in-network, such as your deductible, copay, or coinsurance.

No balance billing: providers generally cannot bill you for the difference between their charge and your health plan’s allowed amount for protected services.

• Emergency services at an emergency department or freestanding emergency room, without prior authorization and without balance billing for protected services.
• Non-emergency care from an out-of-network provider at an in-network hospital or facility, including many ancillary services such as anesthesiology, radiology, pathology, neonatology, assistant surgeons, hospitalists, intensivists, and some lab services.
• Air ambulance services, if your health plan covers air ambulance services.

• Ground ambulance services are not fully covered by the federal No Surprises Act.
• Services that your health plan does not cover.
• Out-of-network care you choose after signing a valid Notice and Consent form, for services where consent is allowed.

Patients who do not have insurance, or who are not using insurance, have the right to request a Good Faith Estimate from their provider for non-emergency services. This may include related costs such as testing, prescription drugs, equipment, and hospital fees.

You will not receive a Good Faith Estimate during emergency care.

If you schedule care at least 3 business days in advance, you should receive a Good Faith Estimate. If you request a Good Faith Estimate before scheduling care, it should generally be provided within 3 business days.

• If care is scheduled 3 to 9 business days in advance, the estimate should generally be provided within 1 business day after scheduling.
• If care is scheduled 10 or more business days in advance, the estimate should generally be provided within 3 business days after scheduling.

A Good Faith Estimate includes expected charges for items or services reasonably needed for your scheduled care. This may include facility fees, hospital fees, tests, medications, equipment, and other expected charges. Actual costs may change if your needs change during care.

If your final bill is at least $400 more than your Good Faith Estimate, you may be able to use the federal Patient-Provider Dispute Resolution process. The dispute generally must be started within 120 calendar days of receiving the bill.

When you see a doctor or health care provider, you may owe out-of-pocket costs such as a copay, coinsurance, or deductible. You may have other costs or have to pay the entire bill if the provider or facility you visit is not in your health plan’s network.

Out-of-network providers and facilities have not signed a contract with your health plan and 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.

Surprise billing is an unexpected balance bill. This can happen when you cannot control who is involved in your care, such as during an emergency department visit.

No. Emergency services must be covered without prior authorization.

You are still protected for certain services unless you voluntarily sign a valid Notice and Consent form for services where consent is permitted. Many ancillary services cannot use consent and remain protected.

1. Do not pay yet. Call us at (806) 266-5566 ext. 237.
2. Ask for an itemized bill and check whether the provider or facility was in-network and whether the service is protected.
3. Contact your health plan and reference the No Surprises Act.
4. If you are uninsured or self-pay and your bill is at least $400 more than your Good Faith Estimate, ask about the Patient-Provider Dispute Resolution process.
5. You can also contact the No Surprises Help Desk at 1-800-985-3059.