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The "No Surprises" Act

NYPT patients should be aware of the "No Surprises" Act.The federal "No Surprises" Act went into effect on 1/1/2022. Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance a Good Faith 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 does not include any unknown or unexpected costs that arise during treatment. You could be charged more if complications or special circumstances occur. Make sure your healthcare 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 healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you are billed for more than the Good Faith Estimate of medical costs:

  • You have a right to dispute the bill

  • You can ask the provider for an updated bill to match the Good Faith Estimate

  • You can ask to negotiate the bill

  • You can ask if there is financial assistance available

  • You have a right to initiate a patient-provider dispute resolution process with the US Department of Health and Human Services if the actual billed charges substantially exceed (by at least $400) the expected charges included in the Good Faith Estimate.

    • If you choose this route, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill

    • There is a $25 fee (paid to US Department of HHS) to use the dispute process

    • If the agency reviewing your dispute agrees with you, you will have to pay the price of the Good Faith Estimate

    • If the agency reviewing your dispute disagrees with you and agrees with the provider, you will have to pay the higher amount

 

The initiation of a patient-provider dispute resolution process will not adversely affect the quality of healthcare services furnished to you.

Make sure to save a copy or picture of your Good Faith Estimate. There may be additional items or services the provider may recommend as part of the course of care that must be scheduled or requested separately and are not reflected in the Good Faith Estimate.Upon request, the Good Faith Estimate can be updated.The information provided in the Good Faith Estimate is only an estimate; actual items, services, or charges may differ from the Good Faith Estimate.The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from the provider.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 866-226-1819.

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