The No Surprises Act And Good Faith Estimates

Quest ion:

A patient was given an estimate on 3/20/23 and 4/20/23 for the same upcming service, however the estimates were very different The higher estimate is more accurate in the charges. What is our responsibility in honoring the lower estimate?

Answ er:

The estimate is not a contract, so the patient is still responsible for billed charges. The intent of the estimate is to allow the patient to shop for prices at multiple facilities/providers and have a written document to use should the billed charges exceed that GFE As we discussed, even though the second GFEwas calculated incorrectly and issued in error, it gave the patient the expectation of a lower cost The patient can use that second estimate to initiate a dispute since the billed charges exceeded the second estimate by $400. Fortunately, the error was discovered before they initiated a dispute, so negotiations can occur between the facility and patient outside the formal dispute process

The facility must determine if, and how much, they want to reduce the billed charges to avoid the formal dispute and do service recovery The certified dispute resolution entity fees range in price from $350 - $700. The patient could possibly win the formal dispute costing the facility up to $700 in dispute fees and reimbursing the patient the $25 dispute fee.

More consumer information about the dispute process can be obtained at this link: Dispute a medical bill | CMS