Under the federal No Surprises Act, effective January 1, 2022, you have rights that protect you from unexpected medical bills.
We are committed to transparency in billing and to ensuring you understand your costs before receiving care.
The No Surprises Act is a federal law that protects patients from unexpected out-of-network medical bills in certain situations. It limits the amount you can be charged for emergency care and non-emergency care at in-network facilities where out-of-network providers are involved, without your prior knowledge and written consent.
In most cases, your cost-sharing - such as copays, coinsurance, and deductibles - cannot exceed the in-network rate even when an out-of-network provider is involved in your care. Any additional costs are settled between the provider and your health plan, not passed on to you.
You have the right to receive a Good Faith Estimate (GFE) of expected costs before you receive any scheduled service or item. A Good Faith Estimate is a written notice that explains how much your medical care will cost based on what is reasonably expected.
You are entitled to a Good Faith Estimate if you are uninsured or if you are insured but choose not to use your insurance for a particular service. Your estimate will include the expected cost of your primary service as well as any related items and services reasonably expected to be provided at the same time.
To request a Good Faith Estimate, contact the provider's office at least 3 business days before your scheduled appointment. For estimates on services scheduled at least 10 business days in advance, providers are required to deliver the estimate within 3 business days of your request.
You are protected from surprise billing in the following situations. For emergency care, you cannot be billed more than your in-network cost-sharing amount, regardless of whether the provider or facility is in your network. For non-emergency care at an in-network facility, you cannot be billed at out-of-network rates by a provider you did not choose and were not informed about in advance.
Health providers are required to obtain your written consent before treating you at out-of-network rates for non-emergency scheduled services. You always have the right to say no to out-of-network care and to request an in-network provider instead.
If you receive a bill that is at least $400 more than your Good Faith Estimate and you are uninsured or self-pay, you have the right to dispute the bill through the federal Independent Dispute Resolution (IDR) process.
You must initiate a dispute within 120 days of receiving the bill.To start the dispute process or to learn more, visit the CMS No Surprises Help Desk at cms.gov/nosurprises or call 1-800-985-3059.
As a Medicare Advantage IPA, most of our patients are enrolled in Medicare Advantage health plans. Medicare Advantage members have additional protections under CMS regulations, including limits on out-of-pocket costs, access to in-network providers, and the right to appeal coverage and billing decisions through their health plan.
If you are a Medicare Advantage member and have a billing concern, we encourage you to first contact your health plan directly using the member services number on your insurance card. You may also contact our office for assistance navigating your benefits.
If you believe you have been billed incorrectly or your rights under the No Surprises Act have been violated, you may file a complaint with the Centers for Medicare and Medicaid Services (CMS):
Centers for Medicare & Medicaid Services (CMS)
No Surprises Help Desk1-800-985-3059 | Available 8am - 8pm ET, 7 days a week
cms.gov/nosurprises
You may also contact our billing team directly if you have questions about a specific charge or would like help understanding your explanation of benefits.
This disclosure is provided in accordance with the federal No Surprises Act (Public Law 116-260) and CMS implementing regulations. It applies to services provided through the MD Senior Care Medical Group provider network. This page does not constitute legal or billing advice. We recommend periodic review with qualified healthcare compliance counsel.
Last revised: April 7, 2025
