The "No Surprises" Act became effective Jan 1st, 2022. Congress included this in the Consolidated Appropriations Act of 2021. It is designed to protect patients from surprise at bills they received for emergency services with out-of-network facilities, or out-of-network providers at in-network facilities. The "No Surprises Act" also enables uninsured patients to receive a good faith estimate of the cost of care. This act covers all medical procedures and services, not just behavioral health care.

 

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Good Faith Estimate

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.

• You can have a good faith estimate one business day prior to your initial session. Timelines are estimates with many variables. Timeline may vary depending upon the initial assessment and through-out treatment. You can discuss treatment frequency at any time. Rates may increase yearly to adjust with inflation and living costs. Clients will be notified within 60 days of any changes.

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

• You will be able to access your copy through the client portal. 

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Billing Disclosures – Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

 

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a co-payment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

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“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care–like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. You are protected from balance billing for emergency services.

 

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (co-payments, coinsurance, and deductibles that you would pay if the provider or facility was in-network).

• Your health plan generally must:

  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).

  • Cover emergency services by out-of-network providers.

  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.

  • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

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Get More Information

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-MEDICARE (1-800-633-4227).