Client rights and protections against surprise billing

Last updated: Mar 13, 2024

 

Under the No Surprises Act (NSA), uninsured and commercially insured patients who choose not to use their benefits are entitled to a good-faith estimate (GFE) of charges from Clearview Mental Health before scheduled services. If the actual charges by a particular clinician or facility exceed the GFE amount by more than $400, the patient is entitled to dispute the charges under an arbitration process.

 

Good-faith estimates (GFEs) for self-pay and uninsured patients

A good-faith estimate shows the costs of services that are reasonably expected for the expected services to address your mental health care needs. The estimate is based on the information known to us when we did the estimate. 

 

The good-faith estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. Federal law allows you to dispute (appeal) the bill if this happens.   

 

You have the right to dispute the bill if you are billed for $400 more (per clinician) than this good-faith estimate (GFE). 

 

If the billed charges are at least $400 higher than the GFE, you may contact Clearview Mental Health to let us know. You can ask us to update the bill to match the GFE, negotiate the bill, or ask if financial assistance is available. Please message us via your patient portal message center or at 1-614-930-2750.

 

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use this process, you must start it within 120 calendar days (about four months) of the date on the original bill.  

 

The dispute process costs $25. If the agency reviewing your dispute agrees with you, you must pay the GFE price. If the agency disagrees with you and agrees with Clearview Mental Health, you will have to pay a higher amount.  

 

To learn more and get a form to start the process, go to: 

 

www.cms.gov/nosurprises or call CMS at 800-985-3059.

 

For questions or more information about your right to a good-faith estimate or the dispute process, visit www.cms.gov/nosurprises or call CMS at 800-985-3059.