YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
(OMB Control Number: 0938-1401)

Effective January 1, 2022, Congress passed the No Surprises Act as part of the Consolidated Appropriations Act of 2021. It provides two essential protections for patients. 1) designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. 2) enables uninsured individuals to receive a good faith estimate of the cost of care.

For questions or more information, about your right to a Good Faith Estimate, Visit www.cms.gov/nosurprises or call 512-522-4148. OR Visit www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for information about your rights under Federal law.  OR Visit www.tdi.texas.gov/tips/texas-protects-consumers-from-surprise-medical-bills.html for more information about your rights under Texas law.

No Surprises Act / “Good Faith Estimate”

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as co-payment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill of you see a provider or visit a health care facility that isn’t in your health plan’s network. 

“Out-of-network” describes providers and facilities that do not have 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”. This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.  “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care - like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

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 individuals seeking services who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • 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.

  • Your health care provider should give you a Good Faith Estimate in writing at least one business day before your medical service. You can also ask your health care provider for a Good Faith Estimate before your schedule a service and at any time during service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • Make sure to save a copy or picture of your Good Faith Estimate for future reference.

If you believe that you’ve been wrongly billed, you may contact: