Good Faith Estimate/No Surprises Act

According to the “No Surprises Act,” you have certain rights and protections against receiving surprise medical bills. This includes the psychotherapy services I provide, which are non-emergency mental health services.

If you don’t have health insurance or are not using insurance, you have the right to receive a “Good Faith Estimate,” explaining how much your care may cost before such care is provided. The estimate should list expected charges for services from your healthcare provider. It is not a bill and is based on information known at the time the estimate is provided, meaning it won’t include any unknown or unexpected costs that may be added during your treatment.

Whether you save a copy or take a picture of your estimate, make sure to keep it in a safe place: If you receive a bill at least $400 or more than your Good Faith Estimate, you may be eligible to dispute the bill.

Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law. If you think you’ve been wrongly billed, you may use the federal phone number for information and complaints: 1-800-985-3059.

 Additional “No Surprises Act” FAQ

  • When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.

    “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 plan’s deductible or annual out-of-pocket limit.

    “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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

  • Emergency services

    If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

    Certain services at an in-network hospital or ambulatory surgical center

    When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

    If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

    You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

  • You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

    Generally, your health plan must:

    o Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).

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

    o 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.

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