The No Surprises Act went into effect on January 1st, 2022 and establishes new federal protections for patients against surprise medical bills from hospitals, doctors, or other medical providers.
How does this protect consumers?
For consumers who have coverage through their employer (including a federal, state, or local government), through the Health Insurance Marketplace® or directly through an individual health plan, these rules will:
Ban surprise billing for emergency services. Emergency services, even if they’re provided out-of-network, must be covered at an in-network rate without requiring prior authorization.
Ban balance billing and out-of-network cost-sharing (like out-of-network co-insurance or copayments) for emergency and certain non-emergency services. In these situations, the consumer’s cost for the service cannot be higher than if these services were provided by an in-network provider, and any coinsurance or deductible must be based on in-network provider rates.
Ban out-of-network charges and balance billing for ancillary care (like an anesthesiologist or assistant surgeon) by out-of-network providers at an in-network facility.
Ban certain other out-of-network charges and balance billing without advance notice. Health care providers and facilities must provide consumers with a plain-language consumer notice explaining that patient consent is required to get care on an out-of-network basis before that provider can bill the consumer.
For people who are uninsured or elect to not use their insurance, healthcare providers are required to provide a (non-binding) good faith estimate of expected charges, services, and diagnostic codes. If you were to be billed for significantly more than this good faith estimate, you have the right to dispute the bill, request the provider update the bill or the estimate, or start a dispute resolution process with the U.S. Department of Health and Human Services (HHS).
How will this effect therapy if I don't use insurance?
The No Surprises Act doesn't change too much about counseling but rather provides structure and transparency to the conversations we already have. When you complete intake paperwork, you will be provided with a non-binding good faith estimate of services to prevent surprise medical bills. This good faith estimate may be updated if new information, complications or special circumstances occur.
This act does not mean you will pay more for services or that you will be required to report your good faith estimate to anyone. For consumers, it is recommended that you file your good faith estimate with personal records.
For more information on the No Surprises Act, go to https://www.cms.gov/nosurprises