The Department of Health and Human Services has mandated that self-pay patients and patients with non-participating (out-of-network) insurance plans must be given notice of nonparticipating status, consent for treatment, and good-faith estimate of costs by the healthcare facility or provider. These documents must be provided 72 hours in advance of scheduled services. When services are scheduled less than 72 hours in advance, these documents must be provided at least 3 hours prior to the scheduled services.

Emergency services are exempt from the good faith estimate requirement, since such services are not scheduled in advance.

Good Faith Estimate

A Good Faith Estimate (GFE) is a document that outlines the anticipated costs of your medical
care before you receive any services. It’s meant to help you understand what you may need to pay out-of-pocket—especially if you don’t have health insurance or choose not to use it for your care.

The GFE is not a bill, and no payment is required when you receive it. You’ll be provided with a GFE if you don’t have health insurance, or you choose to receive care from Synergy Counseling as an out-of-network provider with your insurance plan.

This estimate gives you clarity and helps you make informed decisions about your healthcare. If you have questions about your GFE or what’s included, we’re here to help. Please contact our office at (800) 552-4357 for assistance.

Balance Billing

Balance billing occurs when a healthcare provider charges a patient for the difference between their fee and what the insurance company pays. However, patients are protected from this practice under the No Surprises Act, which took effect in January 2022. This law prevents providers from sending unexpected bills for emergency services received at out-of-network facilities and for non-emergency care from out-of-network providers working at in-network hospitals. Patients are only responsible for their in-network cost-sharing amounts, such as copays and deductibles. Additionally, uninsured or self-pay patients receive a Good Faith Estimate before treatment, and if the final bill exceeds the estimate by $400 or more, they have the right to dispute it through a formal process. These protections ensure greater transparency and help prevent surprise medical bills.

Disputes

If a patient feels that a non-participating facility or provider has violated any provision of the Surprise Billing Act, they may file a dispute with the Department of Health and Human Services. This includes if the healthcare facility or provider bills in excess of the good faith estimate. The dispute resolution process must start within 120 calendar days (about 4 months) of the date on the original bill. If the agency agrees with the patient, the patient will pay the amount on the good faith estimate. If the agency agrees with the healthcare facility or provider, the patient will pay the higher fee shown on the bill.

More Information About Your Rights and Protections:

• Questions about this notice and estimate? Call (800) 552-4357 or write to referral@scshelps.com

• Questions about your rights? Call the No Surprises Help Desk at (800) 985-3059 or contact South Carolina Department of Insurance at (803) 737-6180 or email them at consumers@doi.sc.gov.