Skip to Main Content

Apply Now to the University of Wyoming apply now
Menu
Contact Us

Division of Communication Disorders

UW Speech and Hearing Clinic

1000 E. University Ave., Dept. 3311

Health Sciences, 160

Laramie, WY 82071

Phone: (307) 766-6426

Fax: (307) 766-6829

Email: SHClinic@uwyo.edu

Notice of No Surprise Act

UW Speech and Hearing Clinic Fee- Audiology

UW Speech and Hearing Clinic Fee- Speech

 

Understanding the Intent of the No Surprises Act

The federal regulation called the No Surprises Act (P.L. 116-260) went into effect January 1, 2022. Congress enacted the No Surprises Act (the Act) to protect patients from costly, unexpected medical bills. The regulation applies to all health care providers, which the Centers for Medicare & Medicaid Services (CMS) defines as “a physician or other health care provider who is acting within the scope of practice of that provider’s license or certification under the applicable state law.” This means that the new regulation applies to both audiology and speech-language pathology providers. However, the provision only applies to patients without insurance who are self-paying or insurance where the provider is considered out-of-network.

 

No Surprises Act + Good Faith Estimates

The regulation includes a provision for Good Faith Estimates, which informs patients of the cost of care they will be receiving before their appointment. Beginning January 1, 2022, audiologists and speech-language pathologists (SLP) are required by law to provide a Good Faith Estimate to every new and established patient who is either seeking treatment as a self-pay patient or is considered out-of-network with you as a provider. A Good Faith Estimate is the best judgment of the cost of care a provider plans to offer to the patient across the episode of care.

To protect patients, the law also requires that the provider’s Good Faith Estimate must be within $400 of the actual charge(s) to the individual for the service(s) you provided. The threshold for “substantially in excess” means that the estimate exceeded the expected charges by at least $400 of what was provided in the Good Faith Estimate. If this occurs, a patient who is self-paying or not using insurance has the right to challenge the bill through a dispute resolution process (called the PPDR). The “substantially in excess” provision applies to the per visit cost as opposed to the total plan of care cost.

 

Patient-Provider Dispute Resolution (PPDR)

Beginning January 1, 2022, a PPDR process will be available for uninsured (or self-pay) individuals who get a bill for an item or service that is substantially in excess of the expected charges on the good faith estimate. Under the PPDR process, the uninsured (or self-pay) individual may seek a determination from a Selected Dispute Resolution (SDR) entity for the amount the individual has to pay. This process can provide the uninsured (or self-pay) individual important consumer protections from billed charges that are substantially in excess of the expected charges in the good faith estimate.

The PPDR process can apply to any item or service furnished by a convening provider, convening facility, co-provider, or co-facility to an uninsured (or self-pay) individual where the total billed charges are substantially in excess of the total expected charges in the good faith estimate. HHS regulations establish that when the billed charges for any provider or facility are in excess of the good faith estimate for that provider or facility by $400 or more, the item or service may be eligible for payment determination by a SDR entity through the PPDR process.

 

Initiating the PPDR process

An uninsured (or self-pay) individual, or their authorized representative, can initiate the PPDR process by submitting an initiation notice to HHS through the online federal IDR portal, submitting an initiation notice electronically, or submitting through the mail if postmarked within 120 calendar days of receiving the initial bill containing charges for the item or service that is substantially in excess of the expected charges in the good faith estimate. HHS strongly recommends that the initiation notice be submitted through the federal IDR portal to help ensure the request can be processed quickly and securely. Additionally, as part of the initiation process, the SDR entity will collect an administrative fee totaling $25. If the PPDR process results in the SDR entity determining a payment amount less 15 than the billed amount, an amount equal to the administrative fee paid will be subtracted from the final payment determination amount.

To find out if you qualify for the dispute resolution process, and prefer to mail in your complaint, please complete this form: Initiating the PPDR Process.

To submit your complaint online please visit this page and follow their prompts: Complaints about medical billing | CMS

 

The online federal IDR portal

When practicable, providers and facilities should use the online federal IDR portal to submit documentation for the PPDR process. The federal IDR portal is the same portal used for the federal IDR process (i.e. payer-provider and payer-air ambulance provider processes). Providers and facilities may also receive notices from HHS and the SDR entity, submit additional supporting documents, and receive the SDR entity’s determination via email.

More information on the federal IDR portal can be found on the portal webpage. More information on the federal IDR portal can be found on the portal webpage located here: CMS - prod - Sign In

 

To learn more and get a form to start the process, go to

https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059.

 

For questions or more information about your right to a Good Faith Estimate or

the dispute process, visit https://www.cms.gov/nosurprises/consumers or call 1-

800-985-3059.

 

Contact Us

Division of Communication Disorders

UW Speech and Hearing Clinic

1000 E. University Ave., Dept. 3311

Health Sciences, 160

Laramie, WY 82071

Phone: (307) 766-6426

Fax: (307) 766-6829

Email: SHClinic@uwyo.edu

1000 E. University Ave. Laramie, WY 82071
UW Operators (307) 766-1121 | Contact Us | Download Adobe Reader

Accreditation | Virtual Tour | Emergency Preparedness | Employment at UW | Privacy Policy | Harassment & Discrimination | Accessibility Accessibility information icon