The federal No Surprises Act, effective January 1, 2022, provides patients with certain protections from unexpected health care bills and establishes cost-transparency requirements for health care providers.

Because Frances H. Yankie, DDS is a dental practice, it is important to understand that the No Surprises Act’s federal balance-billing protections generally do not apply to coverage provided solely through a stand-alone dental insurance plan. Different rules may apply when dental services are covered as part of a medical health plan.

However, the No Surprises Act also provides important protections for patients who are uninsured or who choose not to use insurance to pay for their care. These patients generally have the right to receive a Good Faith Estimate of the expected cost of scheduled dental care.

Good Faith Estimates for Uninsured or Self-Pay Patients

If you do not have health insurance, or if you have insurance but choose not to use it to pay for your dental care, you may be entitled to a written Good Faith Estimate explaining the expected charges for the dental services being considered or scheduled.

A Good Faith Estimate:

• Provides an itemized estimate of the expected charges for the dental items and services reasonably expected to be provided.
• May be requested before you schedule treatment.
• Must generally be provided when qualifying care is scheduled at least three business days in advance.
• Is an estimate and is not a bill.
• May change if your dentist identifies additional treatment needs or circumstances that could not reasonably have been anticipated when the estimate was prepared.

When Should You Receive Your Estimate?

For uninsured or self-pay patients, federal rules generally require a Good Faith Estimate according to the following schedule:

• Care scheduled 3–9 business days in advance: The estimate should generally be provided within 1 business day after scheduling.
• Care scheduled 10 or more business days in advance: The estimate should generally be provided within 3 business days after scheduling.
• Estimate requested before scheduling: The estimate should generally be provided within 3 business days after the request.

If your appointment is scheduled fewer than three business days in advance, the federal Good Faith Estimate timing requirement generally does not apply to that scheduled appointment.

If Your Final Bill Is Substantially Higher Than Your Estimate

If you are uninsured or self-pay and receive a bill from a provider that is at least $400 more than that provider’s Good Faith Estimate, you may be eligible to use the federal patient-provider dispute resolution process.

Federal rules generally require a dispute to be initiated within 120 calendar days of the date on the initial bill.

Keep a copy of your Good Faith Estimate so you can compare it with the bill you receive after treatment.

Dental Insurance and Estimated Patient Costs

If you have dental insurance, our office may provide estimates of your expected insurance benefits and anticipated patient responsibility as a courtesy. Dental benefit information provided by an insurance company is not a guarantee of payment.

Your dental plan determines coverage, limitations, deductibles, maximum benefits, exclusions, waiting periods, frequency limitations, and the amount it ultimately pays. You remain responsible for charges not paid by your dental plan according to the financial policies applicable to your care.

Our Commitment to Cost Transparency

At the office of Frances H. Yankie, DDS in Mill Valley, California, we believe patients should understand the anticipated cost of recommended dental treatment before proceeding whenever reasonably possible.

If you have questions about the cost of treatment, insurance benefits, payment arrangements, or would like to request a Good Faith Estimate, please contact our office before treatment.

Questions About Your Federal Rights?

For additional information about the No Surprises Act, Good Faith Estimates, or the federal patient-provider dispute resolution process, visit:

www.cms.gov/nosurprises

Or contact the federal No Surprises Help Desk at:

1-800-985-3059

Contact Frances H. Yankie, DDS

Frances H. Yankie, DDS
239 Miller Ave. Suite 9
Mill Valley, CA 94941
Phone: (415) 383-0824

Please contact our office if you would like to request a Good Faith Estimate or have questions regarding anticipated treatment costs.

This notice is intended to provide general information concerning rights and protections under the federal No Surprises Act and does not constitute legal advice.