The “No Surprises Act” and Good Faith Estimate

As of January 1, 2022, the Centers for Medicare & Medicaid Services have enacted the No Surprises Act. This new law is intended to reduce the likelihood that patients receive surprise medical bills from their healthcare providers.

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This act attempts to protect consumers/patients from unexpected bills in emergency and non-emergency healthcare settings from Out-Of-Network providers who may become part of their treatment plan. Currently, if consumers have health insurance and get care from an Out-Of-Network provider, their health plan usually won’t cover the entire Out-Of-Network cost; sometimes the patient will be required to pay the difference between their insurance coverage limit and the Out-Of-Network provider’s charge; and sometimes the patient will be required to foot the whole bill. Too often, the patient doesn’t know to expect these Out-Of-Network expenses in advance. These surprise bills can be devastating financially, and this act aims to limit their occurrence.

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An important aspect of this act is the requirement to provide patients with a written “Good Faith Estimate” of the projected costs for medical items or services for uninsured or self-paying individuals. It identifies that if your healthcare costs exceed the Estimate you are provided by $400 or more, you have a right to dispute the bill. Additionally, it establishes a patient-provider dispute resolution process, and provides a way to appeal certain health plan decisions.

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Prior to beginning services with me, you will be provided a Good Faith Estimate along with the suite of new-client documents you will receive via password-protected portal. Updates will be provided along the way as your plan of care changes according to your needs.

To learn more about the No Surprises Act and your rights under that law, go to www.cms.gov/nosurprises or call (800) 368-1019.