No Surprises Act
Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect clients from surprise bills for emergency services at out-of-network facilities or for out-of network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured clients to receive a good faith estimate of the cost of care.
Overview
Surprise billing occurs when clients receive care from out-of-network providers without their knowledge. Surprise billing therefore results in higher costs for medical services that would have been cheaper if rendered by providers inside their health plan’s network. This can happen when someone involved in the client’s care is not in-network. The rule is intended to cut down on surprise costs, and also to ban out-of-network charges without notice in advance (providing clients plain-language consumer notice).
Consumer Notice
Requiring out-of-network providers to provide any of our potential clients with notice that they are outside of the client’s health plan’s network is a large part of the No Surprises Act’s purpose. Any potential client can waive paying out-of-network prices for non-emergency services so long as they consent. We have a standard notice that can be given to out-of-network clients when they seek services, which must be given to clients within seventy-hours of the scheduled appointment or service (or within three hours for same-day-services). At your request, we will provide this notice to you in paper or electronic format, as you prefer, and you will receive a copy.
The form will clearly state:
• The provider (or our facility) is out-of-network;
• An estimate of the cost of our services (which we will calculate in good faith).
You are never required to give up your protections from surprise billing. You also are not required to get out-of-network care. You can choose a provider or facility in your plan’s network.
Lastly, there is a requirement which states that out-of-network providers must notify health plans when they provide a client service, and they must certify that they have met the required notice and consent requirements. We will keep these records for a minimum of seven years.
If you think you've been wrongly billed or have more questions
If you think you have been wrongly billed or are uncertain whether the No Surprises Act applies to you or if you have any additional questions about standard notice forms or the No Surprises Act in general, please contact us. Complaints If you still feel you have been wrongly billed, complaints may be directed to our Compliance Department at 888-5139976 or to the Centers for Medicare & Medicaid Services (CMS) at https://www.cms.gov/nosurprises/consumers or 800985-3059.
Overview
Surprise billing occurs when clients receive care from out-of-network providers without their knowledge. Surprise billing therefore results in higher costs for medical services that would have been cheaper if rendered by providers inside their health plan’s network. This can happen when someone involved in the client’s care is not in-network. The rule is intended to cut down on surprise costs, and also to ban out-of-network charges without notice in advance (providing clients plain-language consumer notice).
Consumer Notice
Requiring out-of-network providers to provide any of our potential clients with notice that they are outside of the client’s health plan’s network is a large part of the No Surprises Act’s purpose. Any potential client can waive paying out-of-network prices for non-emergency services so long as they consent. We have a standard notice that can be given to out-of-network clients when they seek services, which must be given to clients within seventy-hours of the scheduled appointment or service (or within three hours for same-day-services). At your request, we will provide this notice to you in paper or electronic format, as you prefer, and you will receive a copy.
The form will clearly state:
• The provider (or our facility) is out-of-network;
• An estimate of the cost of our services (which we will calculate in good faith).
You are never required to give up your protections from surprise billing. You also are not required to get out-of-network care. You can choose a provider or facility in your plan’s network.
Lastly, there is a requirement which states that out-of-network providers must notify health plans when they provide a client service, and they must certify that they have met the required notice and consent requirements. We will keep these records for a minimum of seven years.
If you think you've been wrongly billed or have more questions
If you think you have been wrongly billed or are uncertain whether the No Surprises Act applies to you or if you have any additional questions about standard notice forms or the No Surprises Act in general, please contact us. Complaints If you still feel you have been wrongly billed, complaints may be directed to our Compliance Department at 888-5139976 or to the Centers for Medicare & Medicaid Services (CMS) at https://www.cms.gov/nosurprises/consumers or 800985-3059.
Right to a Good Faith Estimate
You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost.
Under the law, health care 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. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees (none of which New Hope Counseling Center provides).
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.