No Surprise Act

No Surprises Act

The Biden-Harris Administration has issued requirements related to Surprise Billing that will restrict surprise billing for patients in job-based and individual health plans and who get care from out-of-network provider.  The major features of this legislation is as follows:

  1.  Beginning January 1, 2022, if you are a new or continuing patient who is either uninsured or have an insurance plan that is “out-of-network” with Midwest Center for Human Services or with your specific provider, you may request a “good-faith” estimate of expected cost of your therapy.  This estimate must be provided within three (3) business days upon request and information about services must be provided to you within one (1) business day of scheduling.
  2. If you identify that either of the above describe your situation, please talk with your provider during your initial intake contact.  The details of the services will be discussed with you, and you will be asked to read and sign a series of forms which specify the details and cost of receiving services at Midwest with your provider.  You are under no obligation to sign the form consenting to the cost service from this provider/Midwest.  You may want to check with your health plan to see if an in-network provider is available.
  3. In summary, you are being directed to this page because your provider or Midwest Center for Human Services, LLP is not in your health plan’s network and is considered out-of-network or you are uninsured.  This means that your provider/Midwest does not have an agreement with your plan to provide services.  Getting care from this provider/Midwest will likely cost you more.  You are entitled to a good faith estimate of those services so that you are met with unexpected medical bills.
  4. 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 out-of-pocket limit.  Remember that you are 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.  Under this provision of the NSA, you are responsible for paying your share of the cost (co-payments, coinsurance, and deductibles that you would pay if the provider or facility was in-network).  Additionally, your health plan generally must 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 and count any amount you pay for out-of-network services toward your deductible and out-of-pocket limit.

We understand that these new rules may seem confusing.  If you have questions, please feel free to consult with your provider prior to your first session