No Surprises act Disclaimer
What is the No Surprises Act?
It is a federal law that protects consumers from unexpected medical bills. It went into effect on January 1, 2022 and applies to most health insurance plans and out of network providers.
Why is the No Surprises Act so important?
Before the No Surprises Act, if you had health insurance and received care from an out-of-network provider or an out-of-network facility, even unknowingly, your health plan may not have covered the entire out-of-network cost.
This could have left you with higher costs than if you got care from an in-network provider or facility. In addition to any out-of-network cost sharing you might have owed, 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.
(People with Medicare and Medicaid already enjoy these protections and are not at risk for surprise billing.)
What is a Good Faith Estimate?
If you are uninsured, or if you decide not to use your health insurance for any services, you are protected from surprise medical bills. You have a right to a good faith estimate [GFE] of the cost of your care upfront, before your first visit.
Healthcare providers must give you a cost estimate, in writing, of expected expenses for your care. For example, if you schedule at least 3 business days in advance, make sure your healthcare provider or facility gives you a good faith estimate in writing within one business day after scheduling. If you schedule a healthcare item or service at least 10 business days in advance, make sure your healthcare provider or facility gives you a good faith estimate in writing within 3 business days after scheduling. You can also ask any healthcare provider or facility for a good faith estimate before you schedule an item or service. If you do, make sure the healthcare provider or facility gives you a good faith estimate in writing within 3 business days after you ask.
You, Good Faith Estimate, and the Office of Michelle Solomon, Psy.D
Dr. Solomon is not contractually bound to any health insurance companies, their plans or coverage. Therefore, Dr. Solomon will give you an estimate of costs that are expected for your behavioral health care, based on information known at the time the estimate was created. The estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or unusual circumstances occur. Federal law allows you to dispute (appeal) any bill that is at least $400 more than the original good faith estimate you were given at the outset of treatment. Also, if you and Dr. Solomon agree to additional services, then you will receive a new GFE. You retain the right to appeal any new bill if it is $400 more than that newer good faith estimate.
Know your rights
If you are billed for $400 more than your Good Faith Estimate (GFE), you have the right to dispute the bill.
• You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS) within 120 calendar days (about 4 months) of the date on the original bill.
• There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this GFE. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
For more information about your right to a GFE or if you think you have been wrongly billed, contact:
• No Surprises Help Desk (NSHD) at 800-985-3059, or www .cms.gov/nosurprises