You will receive an easy to understand bill for the services provided by the Surgical Eye Center. You will also receive a bill from your physician and from the anesthesia provider.

As is the custom of other health care facilities in the community, patients or responsible members of their family are asked to make financial arrangements prior to surgery. A pre-operative deposit is required from patients whose insurance policies do not fully cover the charges for their procedure. Self-pay patients are welcome at the center.


The Surgical Eye Center accepts Medicare, Medicaid and most commercial insurance plans. Please check with a member of our staff if you have any questions regarding your bill. You may also contact the billing department at (336) 282-8329.

Good Faith Estimates for Uninsured (or Self-pay) Individuals

As of January 1, information regarding the availability of a good faith estimate must be prominently displayed on the convening provider’s or convening facility’s website, in the office and on-site where scheduling or questions about the cost of healthcare occur.

When scheduling an item or service, providers and facilities are required to ask if the individual has health insurance, and if so, whether they want to have a claim submitted to their health insurance coverage for the item or service they are seeking. If the individual does not have insurance or does not plan on having the claim submitted to insurance, the provider or facility must then inform the individual both orally and in writing of their ability, upon request or at the time of scheduling healthcare items and services, to receive a good faith estimate of expected charges. Please note, the No Surprises Act also includes a requirement that the provider or facility provide a good faith estimate to a health insurance provider if an individual plans to use their insurance; however, rulemaking has not yet been promulgated for that requirement, so enforcement will be deferred. The only good faith estimate requirement that went into effect January 1 is for uninsured (or self-pay) individuals.

The good faith estimate must include expected charges for the items or services that are reasonably expected to be provided together with the primary item or service, including items or services that may be provided by other providers and facilities. For example, for a surgery, the good faith estimate might include the cost of the surgery (both the facility and the physician fees), any labs or tests and the anesthesia that might be used during the operation. Other items or services related to the surgery that might be scheduled separately, such as pre-surgery appointments or physical therapy in the weeks after the surgery, would not be included in the good faith estimate.

Convening provider or facility

To make it convenient for the individual requesting the good faith estimate, a convening healthcare provider or convening healthcare facility (convening provider or convening facility) will be responsible for collecting good faith estimates from the co-providers and co-facilities. The convening provider or facility is defined as “the provider or facility who receives the initial request for a good faith estimate from an uninsured (or self-pay) individual,” or in the case of a request from an individual who has not yet scheduled, it is the provider or facility that would be responsible for scheduling the primary item or service. In the case of services provided at an ASC, the convening provider or facility could be either the physician’s office or the ASC. It is important to remember that whichever provider or facility receives the initial request for a good faith estimate is deemed the convening provider, so that entity may be different for different patients.

Requirements for the Good Faith Estimate

The good faith estimate should use clear and understandable language and include an itemized list of each item or service, grouped by each provider or facility offering care. Each item or service must have specific details and the expected charge. The convening provider or facility must provide a paper or electronic copy of the good faith estimate (based on the patient’s preference) even if the provider also provides the good faith estimate information over the phone or verbally in person.

CMS released a zip drive of resources to help providers comply with the new good faith estimate requirements. These include, among other resources:

  • Appendix 1: Standard Notice: “Right to Receive a Good Faith Estimate of Expected Charges” Under the No Surprises Act
  • Appendix 2: Standard Form: “Good Faith Estimate for Health Care Items and Services” Under the No Surprises Act
  • Appendix 11: Good Faith Estimates: Data Elements

When using the model forms or notices, the provider or facility must fill in the blanks with the appropriate information. While a provider or facility does not have to use the models provided, the provider or facility must make sure that all the necessary elements are included.

Timeline for Good Faith Estimates

The convening provider or facility must provide a good faith estimate to an uninsured (or self-pay) individual:

  • within one business day after scheduling (when the primary item or service is scheduled at least three business days in advance) or no later than three business days after scheduling (when the primary item or service is scheduled at least 10 business days in advance); or
  • within three business days after an uninsured (or self-pay) consumer who has not yet scheduled requests a good faith estimate.

In the Part II rulemaking, HHS notes it will take some time for the convening facility or provider to get systems in place to receive information from co-providers and co-facilities. Therefore, for good faith estimates provided to uninsured (or self-pay) individuals from January 1, 2022, through December 31, 2022, HHS will exercise its enforcement discretion in situations where a good faith estimate provided to an uninsured (or self-pay) individual does not include expected charges from other providers and facilities that are involved in the individual’s care. It is important to note that ASCs are still responsible for the good faith estimate of their facility fees; just not the good faith estimates of co-providers.