No Surprises Act and Your Rights
In compliance with the No Surprises Act that went into effect January 1, 2022, all healthcare providers are required to notify clients (existing clients and new clients) of their Federal rights and protections against “surprise billing.” This Act is intended to protect patients against any "surprise billing" or "balance billing" when receiving care or services rendered by an out-of-network provider, if a client is uninsured, or if a client elects not to use their insurance.
I am required to provide you with a Good Faith Estimate of the cost of services, only at your request. It is difficult to determine the true length of treatment for mental health care, and each client has a right to decide how long they would like to participate in mental health care. Therefore, within the Good Faith Estimate that I can provide to you, there will be a fee schedule for the services typically offered for therapy. We will collaborate regularly to determine how many sessions you may need at a frequency that makes sense for your care.
As a client at Emerge Therapy, you have the right to receive a “Good Faith Estimate” in writing explaining how much your psychotherapy services will cost.
Under the law, healthcare providers must give patients who don't have insurance or are not using insurance an estimate of the bill for medical items and services, upon request.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Ensure your healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your healthcare provider and any other provider you choose for a Good Faith Estimate before you schedule an item or service.
If you receive a bill of at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate from any healthcare provider.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises
It is a Federal requirement that each client signs a "No Surprises Act Disclosure" form and "Good Faith Estimate" form in order to begin/resume treatment. This is included in the Disclosure Statement that must be signed prior to treatment. If you have any questions, please do not hesitate to ask.