When a patient gets treated by an out-of-network provider or facility, they may be unexpectedly billed. This is referred to as “surprised billing”, which unsurprisingly can create many implications for patients.

Enter the No Surprise Act (NSA). This act has been effective since January 1st, 2022, and intends to mitigate the threat of surprise bills by improving healthcare transparency.

If you’d like to avoid legal and financial repercussions as a therapist — it’s essential to understand this new act. This blog post will guide therapists through the No Surprise Act and its essential parts.

Who and How Does the No Surprise Act Protect Patients? 

The No Surprise Act protects patients that are under a group health plan or group or individual insurance cover. This act implements new changes intended to help patients avoid surprising billing. This includes: 

  • No surprise bills for emergency services from an out-of-network provider or facility. 
  • No surprise bills without prior authorization. 
  • No out-of-network cost-sharing, such as out-of-network coinsurance or copayments, for all emergency and some non-emergency services 
  • No out-of-network charges and balance bills for supplemental care, like therapy or anesthesiology, by out-of-network providers that work at an in-network facility.

Mandatory Notifications Under the No Surprise Act 

The No Surprise Act requires all healthcare providers to notify patients about their federal rights and protections against surprise billing. This is done through two means: 

  1. Therapists are required to post a one-page notice that contains information regarding the NSA’s patient protections against surprise billing. The language of this notice must be clear and understandable, and the notice must be made publicly available (e.g., a page on your website, posted in the facility). 
  1. Patients are now entitled to receive a notification when appropriate services are rendered by an out-of-service provider. In addition, if a patient is uninsured or if they choose not to use their insurance, they must also be notified.

Good Faith Estimate Under the No Surprise Act 

The other significant component of the No Surprise Act is something known as the good faith estimate. This estimate is a notification that outlines how much an uninsured or self-paying patient is expected to pay for your services. A good faith estimate is not required if the patient is ensured at the time of scheduling the service. 

Important information related to reasonable faith estimates is as follows: 

  • All reasonable faith estimates must be delivered in writing and must be provided upon request and/or prior to a scheduled appointment. 
  • You can create a good faith estimate for recurring patients for up to 12 months.  
  • Patients have the right to know an expected total cost, which may include related costs such as medical tests, equipment, prescriptions, and hospital fees, if applicable. 
  • If a patient receives a bill that is at least $400 more than the good faith estimate you provided, they can legally dispute the bill. 

Patients need to provide good faith estimates to their patients using these guidelines: 

  • Appointments scheduled 10 business days in advance: good faith estimates must be provided within 3 business days. 
  • Appointment scheduled 3-9 days in advance: good faith estimate must be provided within 1 business day. 
  • When requested: good faith estimate must be provided within 3 business days. \

Good Faith Estimate Advice for Therapists 

As mentioned, if an out-of-service bill is $400 or more than the good faith estimate you provided — the payment may be disrupted. This means you may not get paid for your time or services. 

So, how do therapists avoid this situation? For therapists, it’s essential to regularly assess and reassess your good faith estimates as needed.  

Once you’ve identified a patient’s diagnosis and their course of treatment they may need, update and resend a good faith estimate. If things change with your patient, update and resend as well. Doing so will keep your good faith estimates reliable and accurate.

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