No Surprises Act
Your Rights and Protections Against Surprise Medical Bills
The No Surprises Act, passed by Congress and effective January 1, 2022, established new protections and disclosure requirements against surprise medical billing.
The new law requires healthcare providers and facilities to provide Good Faith Estimates to uninsured and self-paying clients for services offered when scheduling care or when the client requests an estimate.
WHO IS ELIGIBLE TO RECEIVE A GOOD FAITH ESTIMATE?
- UNINSURED CLIENTS: those individuals who do not have benefits for an item or service under a group health plan or health insurance coverage offered by a health insurance issuer or a federal or state health care program or the Federal Employee Health Benefits Program; or
- SELF-PAYING CLIENTS - those individuals who DO have benefits for an item or service under a group health plan or health insurance coverage offered by a health insurance issuer or a federal or state health care program or the Federal Employee Health Benefits Program, but do not seek to submit a claim for such item or service.
- At Riverview Psychological Services, SELF-PAYING CLIENTS are OUT-OF-NETWORK and pay the FULL COST of their services themselves (not just the copay or deductible) without any insurance or healthcare reimbursement. Most Riverview clients have some form of insurance coverage, and they will therefore not receive a Good Faith Estimate.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor, social worker, 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 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’re never required to give up your protections 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.
If you believe you’ve been wrongly billed, you may contact the U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit https://www.cms.gov/nosurprises for more information about your rights under federal law.