THE INITIAL MISSION OF THE NO SURPRISES ACT
EFFECTTVE JANUARY 1, 2022 IS TO PROVIDE GOOD
FAITH ESTIMATES TO PROTECT CLIENTS FROM
SURPRISES FOR CLIENTS WITHOUT INSURANCE PLAN
COVERAGE OR CLIENTS WHO WILL NOT REQUEST
REIMBURSEMENT FROM THEIR HEALTH CARE PLANS
The No Surprises Act took effect on January
l, 2022. This law requires health care
professionals including mental health providers
and physicians of all medical disciplines to
provide "Good Faith Estimates" of charges for
health care services to clients who do not have
insurance or health care coverage or who are not
intending to use their health care insurance to
pay their providers. These clients plan to pay
for health care with "out of pocket" funds. This
Federal law requires providers to give new
clients and even clients already receiving their
services under these circumstances a Good Faith
Estimate for services, when possible, prior to
the first service date or upon request, even if
an appointment has not been made. This procedure
assures that clients will be aware of estimated
expenses for the services they request. The goal
of this act is protection of clients from
unexpected or surprising charges.
All
health care providers including psychologists
like myself are requested to provide clients
estimates for the requested services they intend
to pay "out of pocket." New clients will be
informed of the Good Faith Estimate orally and
in writing prior to our first meeting. I will
provide the Good Faith Estimate in writing by
email or mail a hard copy by USPS. I will ask
clients to sign 2 copies so that they will have
one copy to keep for their records and I will
have one copy for my records. This document will
confirm that clients are informed and protected
by the No Surprises Act.
The No Surprises
Act permits that if charges are $400 or more
beyond the estimated agreed upon charges listed
and approved in the Good Faith Estimate, the
client has the right to bring the charges in
excess of $400 to the attention of the Provider
for discussion; request an updated bill to match
the original Good Faith Estimate; request a
re-negotiated bill consistent with the initial
agreement made; and/or request financial
assistance by means of a courtesy consideration.
If need be, the client may start a dispute
resolution process by going to
www.cms.gov/nosurprises or phone Health and
Human Services at (800) 368-1019.
At any
time, if services are begun, clients are
encouraged to speak with me about any questions
they may have including their treatment plan
and/or the information provided to them in this
Good Faith Estimate.
Clients will receive
from me, as soon as possible when services are
being discussed and scheduled, a copy of this
summary of the No Surprises Act and a personal
letter containing the Good Faith Agreement,
which will estimate charges for the designated
period of treatment to which we agree. This
period of time can and may be modified as
treatment proceeds. If so, at that time a new
Good Faith Estimate will be calculated. When
they receive their Good Faith Estimate, I will
ask them to read it thoroughly, sign the two
copies I provide, keep one copy of the letter
for their records and return one signed copy to
me.
Please print and sign the 2
copies of this notice confirming you are
informed of the No Surprises Act. Keep one copy
for your records and return one signed copy to
me.
Thank you.
Marlene N Kasman, Ph.D