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Good Faith Estimate for Non-Emergency Services

Beginning July 1, 2020, in accordance with Indiana’s House Enrolled Act (HEA 1004-2020); if patients request it, health care practitioners must provide a good faith estimate of the total price they will charge for a non-emergency health care service that has been ordered, scheduled or referred. Patients will not be charged for this information.

The estimates are not binding, the final price may vary from the estimate based on the patient’s medical needs, and the estimate is valid for 30 days.  If you want to discuss your estimate you may do so by calling the Revenue Cycle Management team at (574) 334-5386 or via Navigating Cancer.  We look forward to serving you and will reply within five business days.

Disclaimer: The information provided is a good faith estimate only. It is based on information known at this time about the planned services, is not binding, is not a guarantee of final billed charges, is valid only for services provided by MHO and it’s providers, and is valid for 30 days from the date provided. Final billed charges may vary from good faith estimates for many reasons including, but not limited to: the patient’s medical condition; unknown circumstances, complications, or findings; final diagnosis, and recommended treatment, devices, supplies, and/or services ordered by a practitioner.

For insured patients, provision of this estimate does not guarantee that this episode of care is covered or considered medically necessary by your insurance plan. Final determination of benefits, coverage, eligibility, and payment will be determined by your insurance company based on the terms and conditions of your specific plan. We encourage you to contact your insurance company with any questions or concerns.