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Your billing rights

Your right to a Good Faith Estimate

If you do not have insurance, or you are not using it, you have the right to a Good Faith Estimate — a written estimate of what your care will cost, before it starts. You do not have to argue for it and it does not cost anything. To ask for one, call (805) 210-2288.

  • Ask for one at any time, and Nexa will give it to you within three business days.
  • If you schedule something three to nine business days ahead, you get the estimate without asking, within one business day of scheduling.
  • If you schedule ten or more business days ahead, you get it without asking, within three business days of scheduling.
  • Keep it. If the final bill is substantially more than the estimate, you can formally dispute it — and using that process cannot affect the care you get.
  • "Substantially more" has a set meaning: at least $400 more than the total on your estimate. To dispute a bill you start the federal patient-provider dispute resolution process, and your request has to be postmarked within 120 calendar days of the day you received the first bill. The federal government charges an administrative fee to start it.

Source: 45 CFR 149.610(b)(1)(iii)(A) and (b)(1)(vi)(A)–(C), and the dispute disclaimer at (c)(1)(x). 45 CFR 149.620(a)(2)(ii) defines "substantially in excess" as "an amount that is at least $400 more than the total amount of expected charges listed on the good faith estimate," and 149.620(c)(1) requires the initiation notice to be "postmarked within 120 calendar days of receiving the initial bill" and an administrative fee.

Your protections against surprise medical bills

A surprise bill is what arrives when you did everything right — you went to a place in your health plan's network — and someone who treated you there turned out to be outside it. Federal law limits what you can be charged in that situation.

  • For emergency care, you pay no more than the cost sharing you would owe in network — your normal copay, coinsurance or deductible.
  • For care at an in-network facility from an out-of-network provider, the same limit applies.
  • You cannot be balance billed for the difference, and you are never required to give up these protections. If someone asks you to sign away this right, you may say no, and saying no cannot cost you care.

Source: 45 CFR 149.430(b)(1), which requires this disclosure to explain the prohibitions at 45 CFR 149.410 and 149.420 (Public Health Service Act sections 2799B-1 and 2799B-2), in "clear and understandable language."

If you think you were billed wrongly

Call Nexa first at (805) 210-2288. Many billing problems come down to a code or a date, and a person can often fix those in one call. If that does not resolve it, you can take it to the federal and state agencies that enforce these rules.

What Nexa charges

If you are paying for yourself, call (805) 210-2288 and we will go through the options with you. Whatever you settle on is put in writing before you start. What it costs, and how insurance works has the rest.