Good Faith Estimate for Non-emergency Services
Beginning July 1, 2020, in accordance with Indiana’s House Enrolled Act (HEA 1004-2020); if patients request it, health care practitioners must provide a good faith estimate of the total price they will charge for non-emergency health care service that have been ordered, scheduled, referred, or will be performed in office. This information will be provided within 5 business days unless the nonemergency health care service is scheduled to be performed by the practitioner within 5 business days of the date of the patient's request. Patients will not be charged for this information. The estimates are not binding, the final price may vary from the estimate based on the patient’s medical needs, and the estimate is valid for 30 days.
Disclaimer: The information provided is a good faith estimate only. It is based on information known at this time about the planned services, is not binding, is not a guarantee of final billed charges, is valid only for services provided by SBO and its providers and is valid for 30 days from the date provided. Final billed charges may vary from good faith estimates for many reasons including, but not limited to; the patient’s medical condition; unknown circumstances, complications, or findings; final diagnosis, and recommended treatment, devices, supplies, and/or services ordered by a practitioner.
For insured patients, provision of this estimate does not guarantee that this episode of care is covered or considered medically necessary by your insurance plan. Final determination of benefits, coverage, eligibility, and payment will be determined by your insurance company based on the terms and conditions of your specific plan. We encourage you to contact your insurance company with any questions or concerns.