Dentists now required to give good faith estimates: 7 things to know

Under the No Surprises Act that went into effect Jan. 1, good faith estimates for the cost of care must be given to uninsured and self-pay consumers.

According to the American Dental Association, the act gives consumers new billing protections called good faith estimates when getting emergency care, nonemergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.

If dental coverage is classified as one of the categories of services that good faith estimates apply to, dental components may be affected.

Seven things dentists should know:

  • Good faith estimates apply to uninsured and self-pay consumers who are visiting a private dental office.
  • Uninsured and self-pay consumers are entitled to good faith estimates when requesting the estimate or scheduling a service.
  • Providers or facilities must provide good faith estimates in writing after a request within three business days.
  • No sites of service are exempt from good faith estimates.
  • Though private dental offices are included, they mostly aren't affected by the law's protections against balance billing, because dental benefits are excepted benefits.
  • If the bill exceeds the good faith estimate by at least $400, the individual could initiate a patient-provider dispute resolution process.
  • Good faith estimates don't apply to customers with programs such as Medicare, Medicaid, the Indian Health Service, Veterans Affairs Health Care or TRICARE as they have other protections against surprise bills.

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

Featured Learning Opportunities

Featured Webinars

Featured Whitepapers

Featured Podcast