No Surprises Act

The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022.

How Does the NSA apply at Cedar Counseling & Wellness?

Cedar Counseling & Wellness has always prioritized transparency in billing. We believe in publishing our fees on our website so clients can make informed decisions before scheduling with us. These policies are reiterated in our intake forms, which all clients are required to sign before they begin services with us.

We are a “private pay” or “self-pay” provider, which means that our clients pay in full for their own therapy sessions (we require payment on the day of service). We are not in-network with any insurance companies. We believe in being transparent about our private pay status, to allow clients to make informed decisions before scheduling with us. If seeing an in-network provider is important to you, we are happy to recommend local practices that accept insurance.

We will provide you with a Good Faith Estimate, in compliance with the new federal regulations.

To learn more, please visit: https://www.cms.gov/nosurprises/consumers

No Surprise Medical Bills

What are surprise medical bills?

If you have health insurance and get care from an out-of-network provider or at an out-of-network facility, your health plan may not cover the entire out-of-network cost. This can leave you with higher costs than if you got care from an in-network provider or facility. In the past, in addition to any out-of-network cost sharing you might owe, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid, unless banned by state law. This is called “balance billing.” An unexpected balance bill from an out-of-network provider is also called a surprise medical bill.

What are the new protections if I have health insurance?

If you get health coverage through your employer, the Health Insurance Marketplace®, or an individual health insurance plan you purchase directly from an insurance company, these new rules will:

Ban surprise bills for emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for all emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
Ban out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers who work at an in-network facility.
Require that health care providers and facilities give you an easy-to-understand notice explaining that getting care out-of-network could be more expensive and options to avoid balance bills. You’re not required to sign this notice or get care out-of-network.

What if I don’t have health insurance or choose to pay for care on my own without using my health insurance?

If you don’t have insurance or you choose to pay for care without using your insurance (also known as “self-paying” for care), these new rules make sure you can get a “good faith” estimate of how much your care will cost, before you get care.

You have a right to a Good Faith Estimate

Beginning January 1, 2022, if you’re uninsured or you pay for health care bills yourself (don’t have your claims submitted to your health plan), health care providers and facilities must provide you with an estimate of expected charges before you get an item or service. This is called a “good faith estimate.” Providers and facilities must provide you with a good faith estimate if you request one, or after you’ve scheduled an item or service. It should include expected charges for the primary item or service you’re getting, and any other items or services that are provided as part of the same scheduled experience.

The provider or facility you contact for a good faith estimate must provide a list of all items and services associated with your care. In 2022, the estimate isn’t required to include items and services provided to you by another provider or facility, but you can also ask these providers or facilities for a separate good faith estimate. In 2023, the provider or facility you contact will be required to provide co-provider or co-facility cost information.

For example, if you’re getting surgery, the good faith estimate could include the cost of the surgery, any lab services or tests, and the anesthesia used during the operation. But, in some instances, items or services related to the surgery that are scheduled separately, like pre-surgery appointments or physical therapy in the weeks after the surgery, might not be included in the good faith estimate.

Providers and facilities must:

Provide the good faith estimate before an item or service is scheduled, within certain timeframes.
Offer an itemized list of each item or service, grouped by the provider or facility offering care. Each item or service has to have specific details, like the health care code assigned to it and the expected charge.
Explain the good faith estimate to you over the phone or in-person if you request it, and then follow up with a written (paper or electronic) estimate.
Provide the good faith estimate in a way that’s accessible to you.

Once you receive a good faith estimate from your provider or facility, be sure to keep it in a safe place so you can compare it to any bills you get later. View an example of what a good faith estimate (PDF) may include . If you’ve had your service and find that the billed amount is at least $400 above the good faith estimate, you may be eligible to start a patient-provider dispute resolution process. Learn more about the dispute resolution process, including eligibility requirements and what information or documents you need to start a dispute.