Your right to a Good Faith Estimate

Your right under federal law

Under the No Surprises Act, health care providers must give patients who do not 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 one 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 cms.gov/nosurprises or call 1-800-985-3059.

When you get it

A visit booked for today or the next two business days, such as a same-day sick visit, is too soon for a formal estimate. Ask the front desk for our self-pay prices before you come in.

What it includes

• Each service we expect to provide, with its billing code and our self-pay price
• Tests we expect to run in our office
• Vaccines, and the fee for giving each one
• Your child’s name and date of birth, the reason for the visit and the date, if one is booked

If another provider or a lab is likely to bill you separately, we tell you who, so you can ask them for their own estimate.

You can have your estimate on paper or by email, whichever you prefer.

How to ask

Tell the front desk you will be paying yourself when you book at (541) 555-0148, or email our billing manager, Colleen Byrd, at billing@sagebrookpeds.com.

If your bill is higher than the estimate

Call us first. We will go through the bill with you, and correct it if we made a mistake.

If the bill is at least $400 more than your estimate, you can start the federal patient-provider dispute resolution process within 120 calendar days of the date on the bill. There is a $25 fee, and if the decision goes in your favor, it comes off your bill. We will not send an amount under dispute to collections while it is being reviewed.

Vaccines and help with costs

We take part in the federal Vaccines for Children program. Children without insurance get the vaccines themselves at no charge. There may be a fee for giving each vaccine, and no child is turned away because a family cannot pay it.

Your child may also qualify for the Oregon Health Plan, which has no premiums or copays. See Insurance and Billing.