No Surprises Act

What is it?

The No Surprises Act was designed to protect consumers from receiving unexpected medical bills. For example, you go to an appointment at a medical facility that is in-network with your insurance company, but then you receive care/services from an out-of-network provider. You are then surprised by medical bills that your insurance does not cover. The No Surprises Act also requires both healthcare facilities and individual healthcare providers to furnish uninsured/self-pay patients with a Good Faith Estimate (GFE) of the potential cost of a proposed treatment in a calendar year (given ideally prior to the uninsured/self-pay patient receives treatment).

Clinical Psychology Solutions (and all of our therapists) is a practice that is out-of-network for all insurance. We bill you at the time of service based on the rate and services listed on your Informed Consent for Treatment and Credit Card Agreement forms, and we submit claims to your insurance on your behalf (if you like). Your insurance then reimburses you based on your out-of-network benefits. There are no surprise bills.

No Surprises Act: What you need to know

who does this impact?

The No Surprises Act applies to all healthcare providers and facilities operating under the scope of a state-issued license or certification. No specific specialties, types of service, or facilities are exempt. Clinical Psychology Solutions (CPS) is required to comply with the No Surprises Act.

Any client who is uninsured—or who is insured but does not plan to use their insurance benefits to pay for the health care services provided (like self-pay clients) —should be provided a Good Faith Estimate. As a client at CPS, you are entitled to a Good Faith Estimate.

What does this mean for me?

The No Surprises Act requires providers to give their clients a Good Faith Estimate.

The Good Faith Estimate shows the cost of therapy (or other services) that are reasonably expected to meet your mental healthcare needs within a calendar year. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur.

We are working hard to get Good Faith Estimates prepared for all of our clients.

If you have questions about the No Surprises Act or how it might impact you, please feel free to contact Dr. Anna Nedelisky

Disputes

If you are billed for more than your Good Faith Estimate, you have the right to understand any discrepancies and dispute the bill.

First, contact your therapist to let them know that the billed charges are higher than the Good Faith Estimate. You can ask your therapist for clarification, ask to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process 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 Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 368-1019.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019.