Your Rights

Information on HIPAA and No Surprises Act/Good Faith Estimate

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to implement the requirements of HIPAA. The HIPAA Security Rule protects a subset of information covered by the Privacy Rule.

HIPAA Privacy Rule

The Privacy Rule standards address the use and disclosure of individuals’ health information (known as “protected health information”) by entities subject to the Privacy Rule. These individuals and organizations are called “covered entities.” The Privacy Rule also contains standards for individuals’ rights to understand and control how their health information is used. A major goal of the Privacy Rule is to ensure that an individual’s health information is properly protected while allowing the flow of health information needed to provide and promote high-quality health care and to protect the public’s health and well-being. The Privacy Rule strikes a balance that permits important uses of information while protecting the privacy of people who seek care and healing.

A covered entity is permitted, but not required, to use and disclose protected health information, without an individual’s authorization, for the following purposes or situations:

  • Disclosure to the individual (if the information is required for access or accounting of disclosures, the entity MUST disclose to the individual)

  • Treatment, payment, and healthcare operations

  • Opportunity to agree or object to the disclosure of PHI (Informal permission may be obtained by asking the individual outright, or by circumstances that clearly give the individual the opportunity to agree, acquiesce, or object)

  • Incident to an otherwise permitted use and disclosure

  • Public interest and benefit activities—The Privacy Rule permits the use and disclosure of protected health information, without an individual’s authorization or permission, for 12 national priority purposes:

  1. When required by law

  2. Public health activities

  3. Victims of abuse or neglect or domestic violence

  4. Health oversight activities

  5. Judicial and administrative proceedings

  6. Law enforcement

  7. Functions (such as identification) concerning deceased persons

  8. Cadaveric organ, eye, or tissue donation

  9. Research, under certain conditions

  10. To prevent or lessen a serious threat to health or safety

  11. Essential government functions

  12. Workers Compensation

  13. Limited dataset for research, public health, or healthcare operations

GOOD FAITH ESTIMATE Information:

Under Section 2799B-6 of the Public Health Service Act, healthcare providers and healthcare facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal healthcare program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises