In accordance with The No Surprise Act, enforced by the Department of Health & Human Services, The Corvallis Clinic and its Providers are required to give uninsured and self-pay patients an estimate of the costs to be billed for scheduled items or services or upon request for other non-emergency items or services.
If you are uninsured or identify as a “self-pay” patient:
You have the right to obtain a good faith estimate of charges upon request or upon scheduling an appointment. (45 CFR § 149.610(b)(1)(iii)).
The Corvallis Clinic is required to give you a written good faith estimate within the following appropriate timeframes:
- If the item or service is scheduled at least three (3) business days before the date the item or service is scheduled to be furnished: not later than one (1) business day after the date of scheduling;
- If the item or service is scheduled at least ten (10) business days before such item or service is scheduled to be furnished: not later than three (3) business days after the date of scheduling; or
- If a good faith estimate is requested by a self-pay patient or if a patient inquires about the cost of care: not later than three (3) business days after the date of the request.
* If you are insured, you also may request a good faith estimate of the amount you will be billed for non-emergency items and services that you might like to schedule.
If you get a bill that is at least $400 more for any provider of facility than the total expected charges for that provider or facility on the good faith estimate, there is a new patient-provider dispute resolution (PPDR) process available to you. Under the PPDR process, you may request a payment review and decision from an independent company certified by HHS.
These companies are referred to as Selected Dispute Resolution (SDR) entities. The SDR entity will decide what amount you must pay if your bill is at least $400 more for any provider or facility than your good faith estimate from that provider or facility.
A summary of important information for this process is provided below. For detailed information, you can review the HHS interim final rules (IFR) titled Requirements Related to Surprise Billing; Part II, published on October 7, 2021. https://www.govinfo.gov/content/pkg/FR-2021-10-07/pdf/2021-21441.pdf
***Please 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 the No Surprises Helpdesk at 1-800-985-3059.
