Patient’s Right to Request a Good Faith Estimate
Tri-State Orthopaedic Surgeons, Inc. is committed to assisting patients address their financial concerns and questions about the cost of services before care is provided. Good faith estimates are available upon request for planned services including diagnostic imaging, testing and treatment for a specific condition, illness or procedure.
Good faith estimates will be based on information known at the time of request and are not binding. Billed charges may vary for many reasons including, but not limited to; the patient’s individual needs, medical condition, unknown circumstances, complications, medical equipment and supplies and/or other services ordered by the practitioner.
For insured patients, good faith estimates are not a guarantee coverage for services provided. Final determination of benefits, coverage, eligibility, and payment will be determined by the terms and conditions of your specific insurance plan.
Requests for good faith estimates will be processed within five days of receiving all relevant information and are valid for 30 days from the date provided. To learn more about our services and payment expectations, please call (812) 477-1558.
Our physicians and staff look forward to serving your health care needs.
IC 25-1-9.8 · 08/27/2020