What this means for you
Your costs
- For protected services, you pay only what you would pay in-network (deductible, copay, or coinsurance).
- No balance billing: Providers can’t bill you for the difference between their charge and your plan’s allowed amount.
Good Faith Estimates
- If you’re uninsured or not using insurance, you can get a written estimate of costs before care.
- Scheduling ≥ 3 business days ahead? You should receive the Good Faith Estimate within 1–3 business days, depending on when you schedule.
- If your final bill is $400+ higher than the Good Faith Estimate, you can use a federal dispute process.
When you’re protected from surprise bills
- Emergency services at any emergency department or freestanding ER—no prior authorization, no balance billing.
- Non-emergency care from an out-of-network provider at an in-network hospital or facility (for example, anesthesiology, radiology, pathology, neonatology, assistant surgeons, hospitalists, intensivists, and some labs).
- Air ambulance services (if your plan covers air ambulance).
What’s not covered by the federal law
- Ground ambulance rides (local or 911) are not covered by the No Surprises Act. You may still get a bill; state/local protections may apply.
- Services that your health plan doesn’t cover.
- Out-of-network care you choose after signing a valid Notice and Consent, for services where consent is allowed.
If you get a bill you didn’t expect
- Don’t pay yet. Call us at (806) 266-5566 ext 237.
- Ask for an itemized bill and check if the provider/facility was in-network and whether the service is protected.
- Contact your health plan and reference the No Surprises Act.
- If you’re uninsured/self-pay and your bill is $400+ above your Good Faith Estimate, ask about the Patient-Provider Dispute Resolution process.
- You can also submit a complaint to the federal help center: [Federal Help Center Phone/Portal].
Good Faith Estimates (for uninsured or self-pay patients)
Patients who do not have insurance or who are not using insurance have the right to request a Good Faith Estimate from their provider for non-emergency serivces; this includes related costs such as testing, prescription drugs, equipment, and hospital fees.
When will I get my estimate?
If you schedule care 3–9 business days ahead, you’ll get the Good Faith Estimate within 1 business day. If you schedule 10+ business days ahead, you’ll get it within 3 business days. You can also request a Good Faith Estimate before you schedule, and we’ll provide it within 3 business days.
What’s in the estimate?
Expected costs for items/services reasonably needed for your visit (for example: tests, medications, equipment, facility fees). Actual costs may change if your needs change during care.
What if my bill is higher than my Good Faith Estimate?
If your final bill is $400 or more above your Good Faith Estimate, and you received the bill within the last 120 days, you may use a federal dispute process to have an independent reviewer decide the final amount.
Frequently asked questions
What is “balance billing”?
When you see a doctor or health care provider, you may owe certain out-of-pocket costs, such as your copay and/or deductible. You may have other costs or have to pay the entire bill if the provider or health care facility you visit isn't in your health plan's network.
Out-of-network providers and facilities haven't signed a contract with your health plan and may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charge for a service. This is called "balance billing". This amount is typically 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 visit an emergency department.
Do I need pre-approval for emergencies?
No. Emergency services must be covered without prior authorization.
What if I choose an out-of-network doctor at an in-network hospital?
You’re still protected unless you voluntarily sign a Notice and Consent for services where consent is permitted. Many ancillary services cannot use consent and remain protected.
Need help?
Talk to us
We’re here to help with bills and estimates.
If you’re uninsured or not using insurance, request a Good Faith Estimate.
Phone: (806) 266-5566 ext 237