No Surprises Act

The Public Health Service Act (commonly called the No Surprises Act/NSA) was enacted to protect the public against unexpected charges from their healthcare providers. This would happen sometimes when some portion of their bill was not covered by their insurance, and these out-of-network healthcare services could be unexpectedly burdensome. To fix this, the law requires healthcare providers to provide an estimate of expected charges—a Good Faith Estimate (GFE)—to any clients who do not have insurance or are not planning to be reimbursed through their insurance benefits. As a client of EMM Psychology Services PC, you are entitled to this Good Faith Estimate. We will always do our best to provide this Good Faith Estimate before your first scheduled appointment, but you always have the right to request this estimate from us at any time. The estimate is based on (1) the information you provide us and (2) our professional opinion on what is needed to assess or treat the mental health issue. The total estimated cost is the number of expected hours multiplied by the stated fees.

Please note: mental health assessment and treatment are individualized to each client’s evolving needs.
Any significant changes to the estimated fees will be communicated to you by your provider.

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS

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” (sometimes called “surprise 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

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services

●      Certain services at an in-network hospital or ambulatory surgical center of the client during sessions.

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

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 are never required to give up your protections from balance billing. You also are not 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.

If you believe you’ve been wrongly billed, you may contact New York State at 1-800-342-3736 or email them at surprisemedicalbills@dfs.ny.gov.

Visit https://www.cms.gov/nosurprises/consumer-protections/Payment-disagreements for more information about your rights under federal law. Visit https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_billsfor more information about your rights under New York State law.

The effective date of this notice is January 1, 2022.