Good Faith Estimates & Surprise Medical Bills

Right to Receive a Good Faith Estimate of Expected Charges

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.

  • 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.
  • 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.
  • 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 questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Your Rights and Protections Against Surprise Medical Bills

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.

What is “balance billing” (sometimes called “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.

“Out-of-network” describes providers and facilities that haven’t 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.” 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 are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
  • Your health plan generally must:
    • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, please visit www.cms.gov/nosurprises or call 1-800-985-3059.

After Procedure

What will happen if I am not able to go home?
Admissions to a hospital from a surgery center happen occasionally. In certain circumstances, your physician or anesthesiologist may determine that you need to be transferred to a hospital for additional post operative care.
What if I am not feeling well once I get home?
If you are in serious pain, or exhibit warning symptoms described in your discharge instructions, please call your physician, go to the nearest emergency room or call 911.
What can I eat when I get home?
Your surgeon may have specific recommendations for your post operative diet. We generally suggest that you eat lightly after surgery, and strongly encourage you to drink plenty of fluids. You should avoid alcoholic beverages.
What can I do to help prevent a post operative infection?

In addition to following the recommendations below, follow your post operative instructions carefully and notify your physician if you have any signs or symptoms which concern you.
Take a shower the night before and the morning of surgery. Follow these simple steps:

  1. Wash your hair first with any shampoo.
  2. Wash all of your body using a liquid antibacterial soap and a clean washcloth for each shower.
  3. Rinse well to remove all soap.
  4. Dry your body with a clean towel.
  5. Do not use lotion, cream or powder.
  6. Do not shave or clip the area where the surgery will be done unless your physician directs you to do so.
  7. On the day of your procedure make sure you, your family and any other caregivers wash hands frequently while at the facility and at home following your surgery. Also, do not hesitate to ask members of your health care team at the facility if they have washed their hands!
  8. After your procedure make sure you, your family and any other caregivers wash their hands frequently.  Also, be sure you follow all instructions provided by your health care team regarding the care and cleaning of your surgical site as well as the administration of post-operative medications and bandages.
How will my pain be managed?

The management of your pain is of great importance to us. We will be assessing your level of pain from the time of admission until you receive our post operative call at home. During your stay at the facility, you will be repeatedly asked to rate your pain using a numerical scale (0-10), or for children, the “Faces Pain Scale” (shown below). 

pain faces 2

We will often use a combination of different modalities to help make you comfortable – choosing from oral medications, intravenous medications, nerve blocks, injection of local anesthetic during the surgery, etc. Prior to the surgery, the management of your pain should be discussed with both your anesthesiologist and surgeon. Please feel free to bring up any concerns or fears you may have. Remember that information on pain management gives you the appropriate expectations and hence a smoother, more comfortable recovery. It is important to follow instructions regarding your post operative pain medication closely.  Many pain medications take 20 to 30 minutes to begin to work.  For best results, the pain medication should be taken before the pain becomes too strong.

Can my family be with me after procedure?
Yes. After surgery, you will be taken to a recovery area. A nurse will monitor your vital signs and make sure you are comfortable as the anesthesia begins to wear off. Once you are awake and alert, your family will be invited back to the recovery area. Special arrangements are made for children having surgery.
May I drive home?
No. Patients will not be allowed to drive after a procedure and must make necessary transportation arrangements. If you plan to walk or take public transportation from our facility after a procedure, please make sure you are accompanied by a responsible adult.
Should I continue my usual medications after procedure?
Most patients should continue their usual medications after surgery. Patients who have diabetes and those patients on blood thinners may require some adjustment of their medications. These instructions will be clarified with you before you leave the facility. If you have any questions, please call your surgeon or primary care physician.
How long will I stay after my procedure?
The amount of recovery time varies from patient to patient. After your procedure, a nurse will monitor your vital signs and make sure you are alert and stable. You will be sent home as soon as your health care team feels it is safe to discharge you from the facility.

Before Procedure

What tests are required prior to my procedure?
Any pre-operative tests will be determined by your physician or anesthesiologist and communicated to you prior to the date of your surgery.
Will I be contacted prior to my procedure by the facility?
Yes. You may receive up to three calls. You will be contacted the day prior to surgery by a member of your health care team. This call will include instructions for the day of surgery and answers to any questions you may have. You may also be contacted by someone in the facility’s business office to address financial matters such as your responsibility for co-payments and deductibles. Finally, you may also be contacted by your anesthesiologist.
What should I bring?
  1. Please bring a photo identification and your insurance card(s). Our staff will need to verify and make copies when you check-in on the day of your surgery.
  2. Be sure to bring any medications that you may need during your stay at the facility (e.g., inhaler or insulin).
  3. Please bring a list of all drugs you are currently taking.
  4. Please bring payment of any patient responsibility (e.g. co-payment or deductible)
  5. Please do not bring rings, watches, or other valuables.
Should I arrange a ride to the facility?
Yes. You will not be allowed to drive after surgery. Please arrange for an adult to drive you home and for someone to be with you when you arrive.
What may I eat and drink before procedure?
Your physician or a pre-operative nurse will inform you of eating and drinking restrictions prior to surgery. It is very important that you follow the provided instructions. If you do not, your surgery may be delayed or cancelled.
Should I take my routine medications on the day of procedure?
You will be given instructions regarding medications by your physician or a staff member. Also, as noted above, please be prepared to list all medications (including name and dose) you are taking and to bring any with you that may be needed during your stay (e.g., inhaler or insulin).
What can I do to help ensure that I have the proper procedure on the correct site?
Your safety is our primary concern. Your entire health care team will follow rigorous guidelines regarding site identification and procedure confirmation. National Patient Safety Goals have been developed which require your involvement too. You will be asked numerous times to confirm both the procedure you are having and the surgical site. You should take a very active role in all discussions with your physician, your anesthesia provider and our staff regarding the identification of your procedure and the correct surgical site. most cases, your surgeon will mark the site prior to your procedure.
What can I do to help prevent a site infection?

Take a shower the night before and the morning of surgery. Follow these simple steps:

  1. Wash your hair first with any shampoo.
  2. Wash all of your body using a liquid antibacterial soap and a clean washcloth for each shower.
  3. Rinse well to remove all soap.
  4. Dry your body with a clean towel.
  5. Do not use lotion, cream or powder.
  6. Do not shave or clip the area where the surgery will be done unless your physician directs you to do so.
  7. On the day of your procedure make sure you, your family and any other caregivers wash hands frequently while at the facility and at home following your surgery. Also, do not hesitate to ask members of your health care team at the facility if they have washed their hands!
  8. After your procedure make sure you, your family and any other caregivers wash their hands frequently.  Also, be sure you follow all instructions provided by your health care team regarding the care and cleaning of your surgical site as well as the administration of post-operative medications and bandages.
Are there special considerations for a child having procedure?
We realize that surgery can be frightening for you and your child. The pre-operative call with the facility nurse is a great time to arrange a tour of the facility to ease any fears you both may be experiencing. If your child would like to have a stuffed animal or security blanket for added comfort, feel free to bring these items on the day of surgery. In the case of young children having surgery, it is best to have someone along with the driver to help care for the child on the trip home. If you experience any health changes between your most recent visit with your physician and the date of surgery, notify your physician immediately. Please report even minor changes, such as an elevated temperature, cough or cold. If you cannot reach your physician, please call the facility.
What if I think I might be pregnant?
Please be sure to notify your physician, anesthesiologist and nurse prior to the date of surgery if you think you may be pregnant. The surgical procedure, anesthesia and medications may be harmful to a developing baby.