Good Faith Estimate — No Surprises Act

At Platinum Hearing, 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 Platinum Hearing 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 — Platinum Hearing 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.

Platinum Hearing 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.

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 Platinum Hearing:

• Phone: (480) 631-7194
• Email: info@platinumhearingaz.com
• Platinum Hearing, 7629 E Pinnacle Peak Rd Suite 118, Scottsdale, AZ, 85255

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