NO SURPRISES RULES
The Consolidated Appropriations Act of 2021 established several new requirements for providers of healthcare services to protect consumers from surprise medical bills. These requirements are collectively referred to as the “No Surprises” rules.
Included in this Act are protections that apply specifically to patients that are paying out-of-pocket for skilled services such as physical, occupational and speech therapy because they do not have Medicare or commercial insurance (are uninsured), or their policy does not cover therapy services. In these cases, the Act requires that we provide patients paying privately for skilled therapy services a Good Faith Estimate outlining the expected charges the patient will be responsible for.
This does not apply to out-of-pocket expenses such as co-pays or deductibles that are stipulated by your insurance policy’s coverage guidelines. This is applicable only to those that choose to pay entirely out-of-pocket, also known as private pay, for the services they receive.
The Good Faith Estimate is only an estimate of items/services reasonably expected to be furnished at the time and the final items, services or charges may differ.
Additional items and/or services that are not in the good faith estimate may be recommended by the therapist as part of the course of care, such as intervention by a different discipline, or a referral to a different provider or specialty. These services must be scheduled separately and are not reflected in the good faith estimate. An updated or separate good faith estimate will be provided for any services rendered by HealthPRO Heritage clinicians.
While it is not always possible for a Rehab Therapist to predict in advance exactly how many therapy sessions may be necessary or appropriate for a given person, the Good Faith Estimate form provides an estimate of the cost of services to be provided. Your total cost of services will depend upon the number, type of service and sessions you attend, your individual circumstances, and the type and amount of services that are provided to you.
The patient has the right to initiate the patient-provider dispute resolution process if the actual billed charges are substantially greater than the estimated charges. “Substantially exceeds” means an amount that is at least $400 more than the expected charges listed on the Good Faith Estimate. Initiating the patient-provider dispute resolution process will not adversely affect the quality of services rendered.
You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items and services from any of the providers or facilities identified on the good faith estimate.
More information can be obtained directly from The Centers for Medicare And Medicaid (CMS) website found here: cms.gov/nosurprises
If you have any questions regarding the Good Faith Estimate, or would like to request a Good Faith Estimate, please contact the HealthPRO Heritage billing department at: firstname.lastname@example.org