Good Faith Estimates and surprise bills

Your right to a Good Faith Estimate

A Good Faith Estimate is a written explanation of expected charges for scheduled health care items and services. Federal law gives eligible patients the right to receive an estimate before care. It is intended to help you understand the expected cost and plan ahead. An estimate is based on the information available when it is prepared; it is not a contract, a guarantee of a particular outcome, or a substitute for checking your insurance benefits.

If your care needs or the services planned for your visit change, the final charges may differ from the estimate. If other providers or facilities are involved, their charges may be provided separately. Ask questions before care if you are unsure what an estimate includes.

Who can get one

You can request a Good Faith Estimate if you do not have health insurance or if you choose not to use insurance for a particular service. This includes people who are self-pay for a visit even if they have insurance coverage. Tell us when you schedule that you are uninsured or will not use insurance, and ask for an estimate for the services you expect to receive.

When you'll get it

The timing depends on when care is scheduled:

• If a service is scheduled at least 10 business days in advance, you should receive the estimate at least 3 business days before the service.
• If a service is scheduled at least 3 business days in advance but fewer than 10 business days ahead, you should receive the estimate at least 1 business day before the service.
• If you ask for an estimate before scheduling a service, we will provide it within 3 business days of your request.

If you schedule additional services or make changes to planned care, you may request an updated estimate. Call us if you have not received an estimate within the applicable timeframe.

What it includes

The estimate describes the expected charges for the items and services related to the scheduled care. It may identify the providers expected to furnish them and, where available, diagnosis and service codes. It should also explain that additional services may be recommended during care and may result in charges that are not included in the estimate.

A Good Faith Estimate reflects the planned services known at the time it is prepared. It may not include every service that could become necessary, or charges from a separate provider who has not yet been identified. Contact our Billing Office if you need clarification about a listed item, an expected charge, or whether another provider may bill separately.

If your bill is higher

If you are uninsured or self-pay and receive a bill from a provider or facility that is $400 or more above that provider's or facility's Good Faith Estimate, you may be eligible to dispute the bill through the federal patient-provider dispute resolution process. You must generally start the process within 120 calendar days of the date on the bill. The process may include a fee and an independent reviewer will decide what you owe.

Keep a copy of your estimate, the bill, and any related messages. Follow the instructions with your bill or contact the federal No Surprises Help Desk to learn how to begin and confirm deadlines. You may still ask our Billing Office to review a bill or explain a charge.

Protections if you have insurance

If you have health insurance, the No Surprises Act protects many patients from certain unexpected out-of-network bills. In most cases covered by the law:

• You cannot be balance billed for emergency services, even if the provider is out of network.
• You cannot be balance billed by certain out-of-network providers who treat you at an in-network hospital or other covered in-network facility.
• Your cost sharing for protected services is generally limited to the in-network amount and counts toward your in-network deductible and out-of-pocket limit.

These protections have exceptions and do not apply to every service or situation. Some non-emergency services may be treated differently if you receive required notice and give valid consent. Before care, ask whether providers and facilities are in your plan's network and whether federal protections apply. Review your plan documents and any notice you receive.

How to ask or get help

To request a Good Faith Estimate from Riverbend Medical Group or ask a question about an expected charge, call (614) 938-2740. Tell us which service you are planning and whether you are uninsured or choosing not to use insurance. We can explain how to request an estimate and what information we need.

For federal information about Good Faith Estimates, dispute resolution, and surprise billing protections, visit cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.

Contact

For questions about estimates or billing, contact our Billing Office:

Riverbend Medical Group
Attn: Billing Office
655 N High Street, Suite 210
Columbus, OH 43215
(614) 938-2740