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No Surprises Act

Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.

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.

Are counselors considered providers under this new law?

  • YES. Because counselors are licensed professionals, they are not only prohibited from balance billing their clients, but they are also required to provide a Good Faith Estimate of the client's costs for counseling at the beginning of treatment.

  • Your counselor will collaborate with you to determine estimated costs of counseling services over the course of one year, and provide a fee schedule so there are no hidden costs associated with your counseling treatment.

  • This applies specifically to clients who are uninsured or who choose to utilize services from out of network providers.

  • If you believe that you've been wrongly billed, you may contact the U.S. Centers for Medicare and 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 the federal law.