Good Faith Estimate — No Surprises Act

At Rawls Clinical Audiology, you have the right to know what your hearing care will cost before you commit to it. The federal No Surprises Act (effective 2022) guarantees you a written Good Faith Estimate of expected charges and protects you from unexpected medical bills.

How pricing works at our hearing clinic

Hearing care happens in two distinct stages, and Rawls Clinical Audiology prices each stage transparently.

1. Diagnostic hearing evaluation. Before any treatment can be recommended, your hearing has to be evaluated. The cost of your evaluation is disclosed to you before you schedule — there are no surprise charges attached to the visit itself, and the evaluation is not contingent on your choosing any further service or purchase.
2. Treatment plan. If your evaluation results in a recommended treatment — hearing aids, fittings, custom ear protection, tinnitus management, or other services — Rawls Clinical Audiology provides a written Good Faith Estimate of the expected charges before you commit to the treatment plan. You are never required to accept recommended devices or proceed with treatment.

Your right to a Good Faith Estimate

Under the federal No Surprises Act, every patient — whether uninsured, self-pay, or insured — has the right to receive a written Good Faith Estimate of expected charges for any recommended non-emergency treatment.

A Good Faith Estimate includes:

• An itemized list of services, devices, and fittings expected
• The expected charge for each item
• Applicable service and diagnosis codes
• The provider identifier for the clinician rendering care

You can request your Good Faith Estimate in writing at any point — most commonly after your evaluation, before you decide on a treatment plan. Keep a copy: you may need it if a later bill exceeds the estimated amount.

If you receive a bill that is at least $400 more than your Good Faith Estimate for the treatment plan you agreed to, you have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process.

What "balance billing" means

When you use insurance, you may owe certain out-of-pocket costs such as a copay, coinsurance, or deductible. If a healthcare provider isn't in your insurance plan's network, they may try to bill you for the difference between what your plan paid and what they charged. This is called balance billing, and it can produce an unexpected ("surprise") bill.

Rawls Clinical Audiology works to prevent surprise bills by verifying your insurance coverage before your visit. We'll tell you in advance what your plan is expected to cover, what your estimated out-of-pocket cost will be, and whether any prior authorization is required. When we are in-network with your plan, balance billing beyond your plan's allowed cost-sharing amount is prohibited by contract.

Insurance We Accept

Rawls Clinical Audiology is in-network with the following plans. If your plan isn't listed, please contact us — many plans still provide partial hearing benefits we can help you access.

• Medicare
• Medicaid
• Tricare
• United Healthcare
• Aetna
• Humana
• Cigna
• Anthem Blue Cross Blue Shield

At Rawls Clinical Audiology, we want the billing process to be as clear and transparent as possible. Recent changes across the healthcare system have affected how hearing and audiology services are billed and reimbursed by insurance providers. Because of these changes, coverage and payment amounts may vary depending on your specific insurance plan. Our team works closely with patients to help verify benefits and provide guidance on any potential out-of-pocket costs prior to appointments whenever possible. Insurance Verification Whenever possible, we verify your insurance benefits before your appointment. This helps us better understand your coverage and provide an estimate of any costs you may be responsible for at the time of your visit. Because insurance policies differ widely, benefit verification allows us to minimize surprises and keep you informed. Medicare & Medicare Advantage Many Medicare and Medicare Advantage plans now cover only a portion of hearing-related services. To help create a smoother and more predictable experience for our patients, we may collect estimated balances at the time of your appointment based on the coverage information available to us. Commercial Insurance Plans For patients with commercial insurance plans, we continue to collect co-pays and any estimated out-of-pocket costs at the time services are provided. Because coverage for audiology services varies between plans, we evaluate benefits on an individual basis whenever possible. Deductibles & Out-of-Pocket Costs Out-of-pocket costs are determined by your individual insurance plan and may be subject to your deductible. If insurance does not fully cover services, office visit fees typically range from $150 to $250, depending on the services provided during your appointment. Replacement parts or components for hearing aids are not included in this estimate and may involve additional charges separate from professional services. For individuals and families with limited income, we offer a sliding scale option to help make care more accessible. Patients with Medicaid coverage are billed according to the fee schedules established by their specific plans.

State Balance Billing Protections

In addition to the federal protections above, some states provide additional balance-billing protections that may apply to hearing care services. You can find a list of states and their protections here. Contact your state agency for more information.

If you believe you've been wrongly billed

Contact your state agency, or the U.S. Department of Health and Human Services at 1-800-985-3059, to reach the entity responsible for enforcing the federal surprise-billing protection laws. Visit cms.gov/nosurprises for more information about your rights under the law, including the federal Patient-Provider Dispute Resolution process.

Request a Good Faith Estimate

You may request a written Good Faith Estimate at any point. Contact Rawls Clinical Audiology:

• Phone: (303) 529-2750
• Email: [email protected]
• Rawls Clinical Audiology, 300 S Jackson St, Ste 340, Denver, CO, 80209

Keep a copy of your Good Faith Estimate. You may need it if you are later billed for more than the estimated amount.