INSURANCE

GOOD FAITH ESTIMATE

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers are now required to provide patients who do not have insurance or who are not using insurance, with an estimate of the expected charges for services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including therapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If requested, our practice will explain the expected costs verbally and if required, we may also provide a written estimate. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

An HMO is a Health Maintenance Organization. When you join an HMO, you will be asked to choose a primary care physician (PCP). Your PCP will care for your routine healthcare needs and coordinate any necessary specialty care. Before you can see a specialist, your PCP will request an authorization for a specialty referral based on your health plan's guidelines.

A PPO is a Preferred Provider Organization. When you join a PPO, you will have a choice of providers to seek care from within the PPO network. In addition, you will have a deductible or copay if you go to a provider within the network. A PPO negotiates arrangements with a network of doctors, hospitals, and other providers who accept lower fees from the insurer for their services. Therefore, if you choose to go to a physician or hospital outside your PPO network, you will have much higher out-of-pocket expenses. If you are covered by one of our contracted PPOs, GVM will bill your carrier for services rendered, so you do not have to complete claim forms.

A point of service plan, or POS plan, is a type of managed care health insurance system. It combines characteristics of both the HMO and the PPO. Members of a POS plan do not choose which system to use until the point at which the service is being used.

Medicare Part B is the medical insurance portion of Medicare, which covers physician services, outpatient hospital care, and many other services typically covered under health insurance plans. Part B is financed through monthly premiums paid by enrollees and by contributions from the federal government. If you are covered by Medicare Part B, GVM will bill Medicare for services rendered, so you do not have to complete claim forms. GVM also accepts many Medicare plans, including Medicare Advantage plans that cover the costs of many services not covered by straight Medicare.