No Surprises Act

Self-pay patients have a right to a good faith estimate of expected charges as of Jan 1, 2022.

A provision of the recently implemented No Surprises Act requires all health care practitioners, including doctors of optometry, to provide any uninsured/self-pay patient with a good faith estimate (estimate) upon request. Click here for more information and a sample letter you can send to oppose this new requirement.

  • You must provide an estimate to uninsured or self-pay patients for items and services.

  • The estimate must itemize any out-of-pocket expenses. For example, exam, refraction, glasses, contact lenses, specialty services, etc. For each item, you may include a range.

  • The estimate must be within $400 of the actual cost or the patient may dispute the charges.

  • The estimate must be provided verbally at the time of scheduling and you must follow every verbal estimate with one in writing (paper or electronic) within 1-3 business days, depending on when the appointment is scheduled.

  • You must provide an estimate (verbal and writing) to someone who doesn't schedule an appointment if you or your staff have any discussion regarding the potential costs of items or services.

  • If you discover that additional items or services are needed during an exam, you can issue a new estimate (verbal and writing) before the products or services are provided.

  • The estimate template must include certain information and disclaimers.

  • You must prominently display a notice in your office and website.

  • AOA's webinar provides additional information and specific examples of how the new law will work.