Legal Update: No Surprise Act

By Cisais | Anxiety and Trauma

Jan 03

Happy New Year!

In December 2020, Congress passed the No Surprises Act to reduce unexpected medical bills on patients. This goes went into effect January 1, 2022. New information about this law and requirements just became available. Below you will find information regarding this law and links to gather more information

There are important requirements when seeking out of network care or if you are uninsured. The information is somewhat unclear as to how this impacts our relationship, however I am taking a proactive step to address this and provide notice and documents. 

You will find 2 forms to complete prior to our next appointment. These forms in no way change or supersede our current billing arrangements

  1. A Good Faith Estimate for 2022, based on our highest clinical rates, although your rate may be lower if you have made prior arrangements with your clinician.
  2. A notice of acknowledgment regarding about Good Faith Estimates

Information regarding this law and links to gather more information

According to The Center for Medicare and Medicaid services :

What are surprise medical bills?

If you have health insurance and get care from an out-of-network provider or at an out-of-network facility, your health plan may not cover the entire out-of-network cost. This can leave you with higher costs than if you got care from an in-network provider or facility. In the past, in addition to any out-of-network cost sharing you might owe, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid, unless banned by state law. This is called “balance billing.” An unexpected balance bill from an out-of-network provider is also called a surprise medical bill.

What are the new protections if I have health insurance?

If you get health coverage through your employer, the Health Insurance Marketplace®, or an individual health insurance plan you purchase directly from an insurance company, these new rules will:

  • Ban surprise bills for emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
  • Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for all emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
  • Ban out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers who work at an in-network facility.
  • Require that health care providers and facilities give you an easy-to-understand notice explaining that getting care out-of-network could be more expensive and options to avoid balance bills. You’re not required to sign this notice or get care out-of-network.

What if I don’t have health insurance or choose to pay for care on my own without using my health insurance?

If you don’t have insurance or you choose to pay for care without using your insurance (also known as “self-paying” for care), these new rules make sure you can get a “good faith” estimate of how much your care will cost, before you get care.

Are there exceptions to these protections?

Some health insurance coverage programs already have protections against high medical bills. You’re already protected against surprise medical billing if you have coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE.

Regarding Good Faith Estimates:

Getting cost estimates before you get an item or service if you’re uninsured or self-pay

Beginning January 1, 2022, if you’re uninsured or you pay for health care bills yourself (don’t have your claims submitted to your health plan), health care providers and facilities must provide you with an estimate of expected charges before you get an item or service. This is called a “good faith estimate.” Providers and facilities must provide you with a good faith estimate if you request one, or after you’ve scheduled an item or service. It should include expected charges for the primary item or service you’re getting, and any other items or services that are provided as part of the same scheduled experience.

Thank you for your cooperation!


About the Author

Carmen provides confidential, fee-for-service, psychotherapy services to help both men and women work through their anxiety, performance and procrastination issues. Her practice combines practical advice, support, reality testing and goal-oriented outcomes. Please contact Carmen at 530.601.1003 to learn more.

Click to Call