Good Faith Estimates

Access Carroll is committed to helping people connect to health services.  Your health service costs at Access Carroll will depend upon your:

  • Insurance coverage

  • Family size

  • Family income

  • Type and number of services required to provide you care

Any patient, including self-pay and uninsured, must complete a Sliding Fee Scale Discount Application to determine eligibility of discounted services offered at Access Carroll. A Good Faith Estimate provides an estimate of costs of items and services that are reasonably expected for your health care needs.  The estimate is based on information known at the time the estimate is created.  Access Carroll offers four discount levels from our full service fees. 

Access Carroll provides patients seeking Substance Use Disorder (Addictions) Treatment an estimate of costs associated with treatment.  Any patient desiring an estimate of any service may request a Good Faith Estimate by contacting our office at 410-871-1478. 

Prior to your visit with us, please ensure you have received your Good Faith Estimate.  New patients may receive first-time estimates and discounts based on verbal information.  Any future visit fee discounts require a completed Sliding Fee Scale Discount Application and proof of income documentation.  

Please contact us if you have any questions about your insurance coverage or financial eligibility to receive discounted services at Access Carroll.  We are here to serve you and will work with you regardless of your financial situation.  

Attachments:

Sliding Fee Eligibility Scale:  English / Spanish

Sliding Fee Scale FAQ:  English / Spanish

Sliding Fee Scale Discount Application:  English / Spanish

Substance Use Disorder Treatment Good Faith Estimate:  English / Spanish

 

Disclaimer:  This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service.  The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment.  You could be charged more if complications or special circumstances occur.  If this happens, federal law allows you to dispute (appeal) the bill. If you are billed for $400.00 or more than your Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate.  You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may start a dispute resolution process with the U.S. Department of Health and Human Services (HHS).  If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process.  If the agency reviewing your dispute agrees with you, you will have to pay the full price on the Good Faith Estimate. If the agency disagrees with you and agrees with the healthcare provider or facility, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 877-696-6775.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 877-696-6775.