Protection from balance billing
For many emergency services and certain out-of-network services at in-network facilities, patients generally cannot be charged more than the in-network cost-sharing amount.
Patient rights and transparent billing
No Surprises Act
The No Surprises Act protects patients from many unexpected medical bills. Medallus supports transparent pricing, good faith estimates, and clear billing resources.
Your rights
Protection from surprise medical bills
Federal protections limit many out-of-network surprise bills and give uninsured or self-pay patients rights to cost estimates before scheduled care.
Good faith estimates
Patients who are uninsured or not using insurance can request or receive an estimate of expected charges before scheduled services.
Dispute and complaint options
Federal resources exist to help patients understand rights, submit complaints, and dispute certain bills that do not match required estimates.
Clear billing information
Patients have the right to receive understandable information about charges, network status, and financial responsibility.
Common scenarios
How protections may apply
These examples explain the kinds of situations the No Surprises Act was designed to address.
| Scenario | Patient protection | Example |
|---|---|---|
| Emergency care | You generally pay the in-network emergency cost-sharing amount, even if the emergency facility or provider is out-of-network. | If your in-network emergency room copay is $500, the law is designed to keep you from being balance billed beyond applicable in-network amounts. |
| Certain care at an in-network facility | Some out-of-network clinicians at in-network facilities cannot send separate surprise balance bills for covered services. | If a facility is in network but an ancillary clinician is out of network, patient responsibility is generally limited under the federal protections. |
| Uninsured or self-pay scheduled care | You can receive or request a good faith estimate of expected charges before care. | A written estimate helps you understand expected costs before a scheduled visit or procedure. |
Medallus commitment
Transparent pricing before you walk in
Medallus is built around practical, upfront pricing. Patients should understand the likely cost of care before receiving a bill.
- Regular urgent care visit: $219 and includes X-ray when needed.
- Procedure visit: $319 for services like suturing, splinting, casting, IV fluids, and minor procedures.
- School and Sports Physicals: $30.
- Medallus membership visits can be as low as $10 for active members.
Standard procedure pricing
Review procedure codes and fee information used for billing transparency.
View Complete Procedure Code ListYou have the right to
- Receive a good faith estimate if you are uninsured or paying out of pocket.
- Be protected from balance billing in many emergency situations.
- Pay only applicable in-network cost sharing for many covered emergency protections.
- Choose your provider for non-emergency services when choice is available.
- Receive clear information about billing and network status.
If you receive a surprise bill
- Contact your insurance company to report the bill.
- Keep bills, explanation of benefits, receipts, estimates, and visit documentation.
- Contact the provider billing department to discuss the charge.
- Use federal No Surprises resources if the issue is not resolved.
Good faith estimates
Cost estimates for uninsured and self-pay patients
If you are not using health insurance, federal rules generally require providers to give a good faith estimate when you request one or schedule care far enough in advance.
Expected service costs
The estimate should identify expected charges for the scheduled items and services related to your care.
Itemized details
Estimates are designed to give patients a written breakdown of expected charges rather than a vague total.
Timing matters
For scheduled care at least 3 business days in advance, patients should receive an estimate according to federal timing rules.
Dispute support
A good faith estimate can help support dispute options if a qualifying bill is much higher than expected.
Resources
Patient billing resources
Use these documents and federal resources for notices, rights, privacy, fee information, and No Surprises Act help.
Patient rights and responsibilities
Review patient rights and responsibilities.
View PDFHIPAA notice
Learn how Medallus protects health information.
View PDFProcedure code fee maintenance
Review fee information.
View PDFMedallus billing help
Questions about your bill or need a good faith estimate? Call 877-633-9110.
Call billingCMS good faith estimate guide
Official federal guidance about estimates for patients who are not using health insurance.
Open CMS guideCMS No Surprises resources
Federal resources for surprise billing rights, protections, and help.
Open CMS resourcesBilling questions
Need help understanding a charge?
Our team can help explain Medallus pricing, payments, estimates, and billing documents.