YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS (OMB Control Number: 0938-1401)
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
However, since Anxiety Specialists of St. Louis is an out-of-network private practice, the most relevant protection for you is the “Good Faith Estimate.”
Right to a “Good Faith Estimate”
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.
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Written Estimate: 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.
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Timing: 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.
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Disputes: If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
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Save a Copy: Make sure to save a copy or picture of your Good Faith Estimate.
What is “Balance Billing” (Surprise 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.
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“Out-of-Network”: Anxiety Specialists of St. Louis is an out-of-network provider. This means we have not signed a contract 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.”
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Your Responsibility: Because we are out-of-network, you are responsible for the full fee at the time of service. We will provide you with a Superbill (receipt) that you may submit to your insurance for potential reimbursement, but we cannot guarantee what your specific plan will cover.
For More Information
For questions or more information about your right to a Good Faith Estimate or the No Surprises Act, visit www.cms.gov/nosurprises or call 1-800-985-3059.