No Surprises Act, What you need to know

If you are choosing NOT to use your insurance, using an insurance for which we are unable to bill or are considered out of network, or are a self pay patient receiving a MEDICAL service at our office we may be required to provide you with a good faith estimate.

Good Faith Estimates are not required for emergency services occurring on the same day as they are scheduled, however we will make an attempt to tell you in advance what your charges may be. In most cases these services will be between $0 and $300 and therefore not exceed the $400 maximum discrepancy.

You will receive a Good Faith Estimate for any services scheduled that fall under the No Surprises Act including but not limited to:

Diabetic Eye Care

Glaucoma Care

Retinal Disease management

Cataract management

Continuity of care due to an infection or other problem

Routine eye care and items such as eye glasses and contact lenses are not recognized as medically necessary by CMS and therefore are not covered under the No Surprises Act. The original intention of this act was to reduce surprise medical bills from encounters with out of network providers who attend you at an in network facility such as a hospital or ambulatory service. CMS wanted to disallow balance billing for full price services where the patient does not have a choice of which provider attends to their care. The act has grown to include Facilities that provide testing and ancillary care, but this line has blurred and is not fully defined. To be in current compliance we are assuming our responsibility to its extent while we wait for further clarification.

Please remember, we are always willing to provide you with an estimate for an eyewear purchase, and you are under no legal or ethical obligation to purchase any item (or service) in our office.
If you are unsure about a purchase please ask the optician (Angela Renski) to provide you with a written estimate regarding any eyewear purchase. We can hold a frame for 1 week before returning it to the frame board in some cases.

Good Faith Estimate CMS Disclosure

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate inwriting within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the healthcare provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.

If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.