Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to provide uninsured individuals a “Good Faith Estimate” of expected charges at the time of scheduling or upon request.
The Good Faith Estimate is a projection of the typical costs for services provided to Ohio Kidney Consultants patients who are uninsured at the time of their appointment. The listed amounts are only an estimate; they are not an offer or contract for services.
Professional charges and corresponding costs for Ohio Kidney Consultants for 2023
| Expected Services | Associated CPT Codes | Estimated Out of Pocket Costs |
| Office/outpatient visit for evaluation and management of a new patient | 99201 – 99205 | $71 – 217 |
| Office/outpatient visit for evaluation and management of an established patient | 99211 – 99215 | $55 – $177 |
| Urinalysis, auto/non-automated, with or without microscopy | 81000 – 81003 | $0 – $2.25 |
| Renal dialysis education | G0420 | $107 |
Disclaimer
If your bill is $400 or more over the estimated out-of-pocket costs quoted within your Good Faith Estimate, you have the right to initiate a patient-provider dispute resolution process with the U.S. Department of Health and Human Services within 120 days of receiving your bill. A $25 non-refundable administrative fee is required to start the patient-provider dispute resolution process. The initiation of the patient-provider dispute resolution process will not adversely affect the quality of care provided by our providers.
To learn more about the patient-provider dispute resolution process, or for more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our office at (614) 538-2250.
