NO SURPRISES ACT
No Surprises Act (NSA)
For Our Patients
Beginning January 1, 2022, patients have a right to an estimate of the cost of services they will receive during a procedure or surgery, called a Good Faith Estimate, and more protection from unexpected, or surprise, bills when they receive care from out-of-network providers at in-network facilities. These protections are part of the of Consolidated Appropriations Act of 2021 which includes the No Surprises Act.
Your Rights and Protections Against Surprise Medical Bills. The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.
Good Faith Estimate (GFE)
Under the law, health care providers need to give patients who don’t 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 GFE Good Faith Estimate in writing at least 1 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.
The Good Faith Estimate (GFE) must include the following
- Patient and provider identification;
- Description of the primary service;
- Applicable diagnosis codes, expected service codes, and expected charges; An itemized list of items and services reasonably expected to be furnished as part of the primary service or in conjunction with that service, including their expected charges (including procedures, medical tests, supplies, prescription drugs, durable medical equipment, and any facility fees);
- A list of items and services that the provider anticipates will require separate scheduling; and
- Disclaimers for the benefit of the patient that:
- There may be additional items or services recommended as part of the course of care that must be scheduled separately;
- The GFE is only an estimate;
- The GFE is not a contract between the provider and patient; and
- The patient has the right to initiate the patient-provider dispute resolution process if the actual billed charges are substantially in excess of the those included in the GFE.
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely 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 have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
Surprise Billing Protection Form
The purpose of this document is to let you know about your protections from unexpected medical bills. It also asks whether you would like to give up those protections and pay more for out-of-network care.
You are protected from Balance Billing for
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as co-payments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. See Florida Statute §641.3154; Florida Statute §627.64194.
Certain services at an In-Network Hospital or Ambulatory Surgical Center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in- network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You can choose a provider or facility in you plan's network. See Florida Statute §641.3154; Florida Statute §627.64194; the federal No Surprises Act and subsequent interim final rules.
When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the potentially applicable co-payments, coinsurance, and deductibles that you would pay if the provider of facility was in-network). Health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Based on what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
Center for Medicare & Medicaid Services CMS https://www.cms.gov/nosurprises Understand your rights against surprise medical bills
Kaiser Family Foundation: No Surprises Act Implementation: What to Expect in 2022 https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/
Requirements Related to Surprise Billing, Part II https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/no-surprises-act
If you believe you have been wrongly billed, please contact your team at Greater Orlando Orthopedic Group™ and we will be happy to assist.
Phone (407) 977-4130
Your Orthopedic Specialists
Board-Certified Orthopedic Surgeon
Hip and Knee Replacement Specialist
Dr. Ronald Hudanich pioneered and specializes in non-muscle cutting, robotic-arm assisted hip and knee replacement surgery.
Board-Certified Orthopedic Surgeon
Fellowship-Trained in Trauma
Fracture and Trauma Care
Dr. Robert Meuret is a seasoned traumatologist and fracture surgeon, with extensive training in emergency orthopaedics, arthroplasty, joint revision, and deformity correction.
Board-Certified Orthopedic Surgeon
Subspecialty Trained and Board-Certified in Orthopaedic Sports Medicine
Dr. Brian Vickaryous is one of the few orthopedic surgeons in the area that are subspecialty trained and board-certified in Sports Medicine.
Our focus is to help our patients restore maximum function possible after a traumatic orthopedic incident or when having been diagnosed with a degenerative disease. Our physicians use minimally invasive, robotic-arm assisted surgery wherever appropriate. If you are coping with a sports injury or the pain of arthritis, we are committed to providing you with most compassionate orthopedic care.
Our Patients Say
Our patients are our number one priority. We take great pride in hearing that our patients are happy with the service and care we provide.
We are Here For You!
Dr. Hudanich and the Hudanich Orthopedics® team Thank you for your amazing work. I had right hip surgery in December 2021. Dr. Hudanich used the robotic Total Hip Replacement Direct Anterior Approach which was a huge success for me. My recovery was very fast. I was walking on my own within a few days. I am now 6 weeks out from surgery and back to work and the gym, walking and swimming. Dr. Hudanich was very informative and caring. Absolutely no complaints. If you have to choose an Orthopedic Doctor choose Dr Hudanich you will not regret it trust me. Thanks again Bill BeekerPatient, Doctor Ronald Hudanich
I saw Dr. Meuret for a collarbone break and he was the only doctor in Florida who gave me hope that I would heal my bone without surgery. The break was one that every other doctor recommended surgery for, but luckily I got referred to him through a friend and would recommend him to anyone. He of course was willing to discuss surgery, but didn’t try to push it on me. The bone is showing much healing progress! I am very grateful that there are a few doctors out there who don’t just try to shove pills and procedures at you. All of the staff is exceptionally kind and helpful as well. Definitely come here if you need orthopedic care!Patient, Doctor Robert Meuret
Dr. Vickaryous did a fantastic job on my elderly mother's broken kneecap, after she was in an accident. In fact, she never once had ANY pain in her leg after the surgery, or during her time in rehab. Quite amazing. Highly recommend and thankful he was the one to perform the surgery.Patient, Doctor Brian Vickaryous
We were so lucky to find “The BEST” surgeon in Central Florida to do hip replacement surgeries. The pandemic pushed my husband’s surgery back a year and he ended up in a wheelchair unable to walk. Dr. Hudanich said these were the worst hips he’d ever seen. He did BOTH hips 3 months apart; the last one the end of July 2021. On my husband’s birthday (Nov 4th), he danced the whole night practically non-stop with no problems! Very seldom you’ll find a surgeon with the kind of care, concern, and skill the caliber of Dr. Hudanichs. He is all about his patients needs and concerns and spends as much time with you as needed to answer ALL your questions; so your mind is at ease and you are ready for that new hip! Thank you Dr. Hudanich for making my man whole again and for your love and care for all of us that are fortunate enough to find you! 😊 Jimmie & Janice XOXOXO!Patient, Doctor Ronald Hudanich
Dr. Meuret repaired my broken elbow, which included hardware installation. Afterward, the Occupational Therapists admired his handywork. They told me that it was a difficult procedure done well. I have full range of motion and little post-surgery pain. Thank you, Dr. Meuret.Patient, Doctor Robert Meuret
Had total tear of shoulder tendon along with impingement requiring debridement. Surgery went perfect. Dr. Vickarous demonstrates great care and concern for the patient. Communicates in direct fashion. Thankful he is my doctor.Patient, Doctor Brian Vickaryous
Monday - Friday - 8AM to 5PM. Closed Saturday and Sunday. If you are in pain or if you are having a medical emergency, please call 9 - 1 - 1 or immediately go to the Emergency Room. All copays will be collected prior to services. We will no longer bill copays. Thank you for understanding!