A new consumer protection law called “The No Surprises Act” went into effect on January 1, 2022. Here’s the mandatory notice that is required about this law:

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health 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 expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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 cms.gov/nosurprises.

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing”?

 When you see a doctor or other health care provider, you may owe certain out-of-pocket costs,   such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care – like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency Services

Certain services at an in-network hospital or ambulatory surgical center

If you get other services at these in-network facilities, out-of-network providers can’t balance  bill you unless you give written consent and give up your protections.

You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

·       You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

·       Your health plan generally must:

o   Cover emergency services without requiring you to get approval for services in advance (prior authorization).

o   Cover emergency services by out-of-network providers.

o   Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.

o   Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

The No Surprises Act has a universal waiver form required — which this provider has adapted into an identical online form. All prospective clients may receive this waiver upon request and it will be included with their intake paperwork for review prior to agreement of any services.

This notice constitutes public disclosure of the “Good Faith Estimate”

Note: A Good Faith Estimate is for your awareness only. It does NOT involve your making  any type of commitment.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059. Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.

If you have questions or concerns, please reach out.

If you believe you’ve been wrongly billed, you may contact: Arizona Secretary of State, Katie Hobbs. The website is https://azsos.gov. The main number is 602 542-4285

Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.