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In the past, people have received surprise medical bills because a provider and/or facility were out of network and were billed for the difference between what was billed and what insurance would have allowed if the provider or facility had been in network. This is called balance billing. And now under the No Surprises Act (NSA), that is not allowed and can be disputed.
Medicare and Medicaid programs have had similar rules in place for many years. If you have a dispute and are insured by Medicare and/or Medicaid, contact them directly. They will walk you through the appropriate dispute process.
The Consolidated Appropriations Act of 2021 contains requirements to protect people with private insurance from surprise medical bills. These rules were collectively known as the No Surprises Act.
If you’re insured through an employer, the health insurance marketplace, or have an individual health plan, you should be protected by the No Surprises Act, which took effect January 1, 2022. However, governmental insurance programs like Medicare and Medicaid aren’t covered by the NSA since these programs are already protected against surprise bills and they can be contacted directly when there is a dispute.
Patients covered by the No Surprises Act (NSA) have a right to access emergency care from out-of-network providers without being charged extra. In short, you should not get a big bill that you didn’t expect for that care. Nor should you get a surprise bill for non-emergency care if you go to a facility covered by your insurance.
Your other rights include:
However, The NSA doesn’t prevent all surprises related to out-of-pocket medical costs. Sometimes what seems like a surprise bill has more to do with the structure of your health plan than the bill itself. For example, you may have a high-deductible plan but not realize how much of the deductible you still have to pay.
Review your explanation of benefits to better understand what your insurance covers after you receive care. Then compare that to your bill.
A “good faith estimate” (GFE) is a written statement designed to help project your cost of care. In the case of a planned surgery, for example, a good faith estimate would include:
The NSA says uninsured and self-pay patients (those who pay out of their own pocket) should get a good faith estimate if they want one. If you request a GFE because you’re uninsured or are paying cash, you’re supposed to have this billing estimate in hand 3 hours before same-day care and at least 3 days before an elective procedure.
If your final charges are $400 or more over the good faith estimate, you can dispute it through what’s called the patient-provider dispute resolution process. Disputes must be filed with 120 days of the bill date.
If you received a surprise bill or have questions about the No Surprises Act, you can contact our office. If you still have questions, or you have a dispute that could not be resolved by speaking to us, you can contact the No Surprises Help Desk for free at 1-800-985-3059. You can also file a complaint to the Centers for Medicare & Medicaid Services (click “submit a complaint”) if you feel a provider didn’t adhere to the NSA.
The help desk can be reached from 6 AM to 6 PM MST, 7 days a week.
If you receive a surprise bill, please contact us as soon as possible. If you still have a dispute or have questions you can call the No Surprises Help Desk. In cases where medical debt or collections problems result from a surprise bill, the Consumer Financial Protection Bureau has resources that may help you protect your credit rating.
Our mission is to enhance quality of life by improving eye health and vision through compassionate care, using state-of-the-art technology, and with exceptional patient service.
Our vision is to be recognized as a center of excellence in eye care by exceeding national benchmarks for clinical quality, providing an unrivaled patient experience, and being an employer of choice in the regions we serve. Through the integration of education, research, and our commitment to excellence, we will continue to meet the growing need for access to premium eye care.
We do not compromise on the quality of care we provide. We utilize state-of-the-art technology, facilities, and training to ensure that the communities we serve have access to the highest quality of eye care available.
We are committed to supporting the advancement of care in the communities we serve through our various clinical and administrative functions, clinical research, educational seminars, and clinical collaboration with our professional peers in medicine and optometry.
We strive to provide the best
work experience for our team members through a commitment to professionalism, fairness, kindness, and respect. We seek out those with a positive outlook and provide them with industry-leading training and education to support professional certification, growth, and development in the continuing effort to live our mission.
We put the patient and their needs first. Every decision we make begins with the question, “How does this improve the patient experience?” because every detail of our operation considers the right of our patients to be treated with respect, compassion, kindness, and in consideration of their time and resources.
We can be relied upon, unequivocally, to do the right thing. We seek and embrace the qualities of honesty, fairness, decency
and trustworthiness, and hold them as the expectation for our organization.
We take every consideration of our resources by seeking to eliminate redundant processes, reducing our environmental impact, and by making sound financial decisions that will help mitigate the increasing cost of healthcare in the communities we serve.
Arvada Vision & Eye Clinic is a full-service eye care provider with optometrists, ophthalmologists, and opticians on staff. Contact us today for Medical and optical eye care!