The No Surprises Act and Psychologists
Protecting Patients from Unexpected Medical Bills
The No Surprises Act (NSA) is a federal law that prohibits surprise billing, the practice of balance billing patients for the difference between what their insurance company pays and the provider’s charge for the service. This act took effect on January 1, 2022, and applies to all non-grandfathered health plans, including those offered by employers, unions, and state and federal governments. This article explores into the details of the No Surprises Act and outlines the responsibilities of psychologists in adhering to its provisions.
The No Surprises Act and Psychologists
The NSA, enacted in 2020, emerged as a response to the growing concern over surprise billing practices, where patients faced unanticipated charges for healthcare services rendered by out-of-network providers. This act extends protection to patients seeking mental health services, ensuring that psychologists, like other healthcare providers, adhere to its guidelines.
Psychologists’ Obligations under the No Surprises Act
Psychologists, as healthcare professionals, bear the responsibility of complying with the NSA’s regulations. Key obligations include:
- Providing Good Faith Estimates (GFEs): Psychologists must furnish patients with a clear and detailed GFE, outlining the expected costs of services before treatment commences. This GFE should include the provider’s contact information, a service description, the estimated cost per service, the total anticipated treatment cost, the provider’s network status, and the patient’s right to dispute the GFE.
- Informing Patients of Dispute Resolution Rights: Psychologists must educate patients about their right to challenge unexpected bills. This entails informing them of the dispute resolution process, whether through the provider or the health plan.
- Adhering to Patient Protections: Psychologists must refrain from engaging in balance billing practices, where they charge patients the difference between the insurance company’s payment and the provider’s charge.
- Maintaining Compliance: Psychologists must continuously monitor their practices to ensure adherence to the NSA’s requirements. This includes maintaining accurate records, providing ongoing training to staff, and promptly addressing any compliance issues.
Providing Good Faith Estimate (GFE)
Psychologists are required to comply with the NSA if they provide services to patients who are uninsured, self-pay, or out-of-network. This means that they must provide patients with a good faith estimate (GFE) of the expected cost of their services before treatment begins. The GFE must be in writing and must include the following information:
- The provider’s name and contact information
- A description of the services to be provided
- The expected cost of each service
- The total expected cost of treatment
- The provider’s network status
- The patient’s right to dispute the GFE
Psychologists must also inform patients of their right to dispute unexpected bills. If a patient receives an unexpected bill, they can file a dispute with their provider or their health plan. Keep in mind the following is additional information about the NSA:
- The NSA applies to all non-grandfathered health plans, including those offered by employers, unions, and state and federal governments.
- The NSA does not apply to Medicare or Medicaid.
- The NSA does not apply to services provided by out-of-network providers at in-network facilities.
To summarize,
The No Surprises Act represents a significant step towards achieving a healthcare system that prioritizes patient well-being, transparency, and cost-effectiveness. By adhering to the act’s provisions, psychologists can play a pivotal role in fostering a patient-centric mental healthcare environment, where individuals can access essential services without the fear of unexpected financial burdens.
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