Understanding the No Surprises Act: Your Rights and Protections

What is the No Surprises Act?

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The No Surprises Act is a federal law aimed at protecting consumers from surprise medical bills that can occur when receiving care from out-of-network providers. This often happens in emergency situations or when patients unknowingly receive care from out-of-network providers at in-network facilities. The law establishes new billing protections and requires greater transparency in healthcare pricing.

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Key Protections Under the No Surprises Act:

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1. Emergency Services:

   • You are protected from surprise billing for emergency services. These services must be billed at in-network rates, regardless of whether the provider or facility is in-network or out-of-network.

   • Emergency services include those provided in hospital emergency departments and freestanding emergency departments.
      

2. Non-Emergency Services at In-Network Facilities:

   • When you receive non-emergency care at an in-network facility, you are protected from surprise bills if the care is provided by an out-of-network provider. This includes services such as anesthesia, radiology, and laboratory services.

   • Out-of-network providers cannot bill you more than the in-network cost-sharing amount for these services.
      

3. Advance Notice and Consent:

   • Providers must give you notice and obtain your consent before providing out-of-network care in non-emergency situations. This notice must include a good faith estimate of the costs and inform you of your rights under the No Surprises Act.
      

Good Faith Estimate:

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• What is a Good Faith Estimate?

  • A Good Faith Estimate provides an estimate of the expected charges for your healthcare services. This includes the cost of therapy sessions, any additional services, and related fees.

  • You have the right to request a Good Faith Estimate if you are uninsured or self-paying for your therapy services.
     

• How to Request a Good Faith Estimate:

  • Contact our office at [Your Contact Information] to request a Good Faith Estimate. We will provide this information in a timely manner, allowing you to make informed decisions about your care.
     

Your Responsibilities:

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• Review Your Insurance Coverage:

  • Understanding your insurance plan, including which providers and facilities are in-network, can help you avoid unexpected costs.

  • Contact your insurance provider for detailed information about your coverage and any potential out-of-pocket expenses.
     

• Ask Questions:

  • If you have any questions about your bill or the services you are receiving, please reach out to our billing department. We are here to assist you and ensure you have a clear understanding of your financial responsibilities.
     

Dispute Resolution:

• If you receive a bill that you believe is incorrect or higher than expected, you have the right to dispute it. The No Surprises Act provides a process for resolving billing disputes, ensuring that you are not overcharged for services.
   

Contact Us:
 

For more information about the No Surprises Act and how it affects your therapy services, please contact us at neilmartin@neilmartinpsyd.com or 404-410-2448. Our team is dedicated to providing you with the information and support you need to navigate your healthcare journey without financial surprises.