No Surprises Act · Good Faith Estimates
You have the right to know what your care is expected to cost.
If you do not have health insurance or choose not to use your health insurance to pay for care, federal law generally gives you the right to receive a Good Faith Estimate of expected charges before receiving scheduled healthcare services.
If you are uninsured or do not plan to use your health insurance to pay for a healthcare item or service, you generally have the right to receive an estimate when you request one or when qualifying care is scheduled sufficiently in advance.
Who This Applies To
Good Faith Estimates primarily protect uninsured and self-pay patients.
For purposes of these federal protections, whether you have insurance is only part of the question. The rules can also apply when you have coverage but choose not to use it for the care you are seeking.
You do not have health insurance.
If you are paying for healthcare without applicable health insurance coverage, you generally have the right to receive a Good Faith Estimate when federal requirements apply.
You have insurance but choose not to use it.
If you tell Alderon that you do not want a claim submitted to your applicable health plan and intend to pay for the care yourself, you may qualify as a self-pay patient for Good Faith Estimate purposes.
You want cost information before scheduling.
An uninsured or self-pay individual may request a Good Faith Estimate before scheduling the healthcare item or service.
When You Receive the Estimate
Federal timing depends on when care is scheduled or requested.
These timeframes apply to Good Faith Estimates for uninsured or self-pay individuals under the federal No Surprises Act requirements.
What’s in a Good Faith Estimate?
Expected charges for reasonably anticipated care.
A Good Faith Estimate identifies expected charges associated with the item or service being estimated based on information reasonably available when the estimate is prepared.
The actual Good Faith Estimate document provided to you will contain the information required by applicable federal rules.
An estimate may identify:
- The patient and healthcare provider
- The primary healthcare item or service
- Expected charges
- Applicable service or procedure information
- Items or services reasonably expected as part of the period of care
- Information about separately scheduled care when applicable
- Required federal disclaimers and patient protections
Understanding Your Estimate
A Good Faith Estimate is important—but it is still an estimate.
Healthcare needs can change after an estimate is prepared. The estimate is based on information reasonably known before the care occurs.
It shows expected charges.
The estimate is intended to help you understand the charges reasonably anticipated for the scheduled healthcare items or services.
It is not your final bill.
You should keep the estimate and compare it with the actual bill you receive after care.
Unanticipated care may affect charges.
Additional items or services may sometimes become clinically necessary based on information that could not reasonably have been anticipated when the estimate was prepared.
Care Outside Alderon
Outside healthcare organizations may have separate charges.
Alderon is telehealth-first, so your care may sometimes involve independent laboratories, imaging centers, pharmacies, specialists, hospitals, or other organizations.
Lab services
Independent laboratories may bill separately for testing they perform.
Diagnostic services
Imaging centers and other diagnostic providers may have separate charges and estimate obligations.
Medications
Prescription and pharmacy costs are generally separate from professional charges for Alderon care.
Other clinicians
Specialists, hospitals, urgent care centers, and other healthcare providers may issue their own bills and, when applicable, separate Good Faith Estimates.
If the Bill Is Higher
Federal dispute rights may apply when a bill is substantially higher than the estimate.
For eligible uninsured or self-pay patients, the federal Patient-Provider Dispute Resolution process may be available when a provider or facility’s billed charges are at least $400 higher than that provider or facility’s Good Faith Estimate.
Keep your Good Faith Estimate.
Save the paper or electronic estimate so you can compare the expected charges with the bill you later receive.
Compare it with your bill.
Review the charges from each provider or facility and compare them with the corresponding expected charges.
Look for the $400 threshold.
You may qualify for the federal dispute process when a provider or facility billed at least $400 more than that provider or facility’s estimate and the other federal eligibility requirements are met.
Act within the federal deadline.
Current federal guidance generally requires an eligible dispute to involve an initial bill dated within the previous 120 calendar days.
Use the federal dispute process.
An independent third party reviews eligible Patient-Provider Dispute Resolution cases and determines the appropriate payment amount under the federal process.
Request an Estimate
Tell Alderon when you are uninsured or choosing to self-pay.
Alderon’s scheduling and financial workflow will identify eligible patients and provide Good Faith Estimates in accordance with applicable federal requirements.
Have a question about your expected charges?
Use Alderon’s general Contact page for administrative questions about pricing or requesting a Good Faith Estimate. Do not include symptoms, diagnoses, medication information, or other protected health information in a general website message.
Federal No Surprises Help
You can also get help directly from the federal government.
The Centers for Medicare & Medicaid Services provides information about Good Faith Estimates, medical-bill rights, complaints, and the Patient-Provider Dispute Resolution process.
Medical Bill Rights
CMS provides current federal information about Good Faith Estimates and protections under the No Surprises Act.
Visit CMS1-800-985-3059
The federal No Surprises Help Desk provides assistance with questions about No Surprises Act protections.
Patient-Provider Dispute Resolution
Eligible uninsured and self-pay patients may use the federal dispute process when applicable requirements are satisfied.
Review dispute rightsFederal requirements, thresholds, forms, and procedures may change. CMS resources linked above should be used for the most current federal information.
Clear Costs · Clear Expectations
Understanding expected costs is part of making informed healthcare decisions.
Alderon is committed to providing applicable uninsured and self-pay patients with Good Faith Estimates in accordance with federal requirements and to making financial expectations as clear as reasonably possible before scheduled care.