Disclaimers and Privacy Policy

The "Good Faith Estimate" (GFE) and the "No Surprises Act" are both legislative measures in the United States aimed at increasing transparency and protecting consumers from unexpected and often exorbitant healthcare costs. Here's an overview of each:

Good Faith Estimate (GFE):

The Good Faith Estimate is a provision under the Affordable Care Act (ACA) that requires healthcare providers and facilities to provide patients with a written estimate of the expected costs of medical services before they are provided. This estimate is intended to give patients a clear understanding of the potential financial responsibilities associated with their healthcare.

Balanced billing, also known as balance billing, refers to the practice of a healthcare provider billing a patient for the difference between the provider's charge for a medical service and the amount covered by the patient's insurance plan. This occurs when the healthcare provider is considered out-of-network by the patient's insurance plan.

Here's a breakdown of how balanced billing typically works:

• In-Network vs. Out-of-Network: In-network providers have negotiated contracts with specific insurance plans, agreeing on set fees for services. When a healthcare provider is in-network, they accept the insurance plan's approved amount as full payment for covered services. Out-of-network providers do not have negotiated contracts with the patient's insurance plan. As a result, they may charge their own rates for services.
• Insurance Coverage: Insurance plans typically cover a certain percentage of the cost for services provided by out-of-network providers. However, this coverage is often limited, and patients may be responsible for a higher share of the costs.
• Provider Charges: The healthcare provider charges a specific amount for a service. This is often referred to as the provider's billed charge.
• Balance Billing: If the provider's charge exceeds the amount covered by the insurance plan, the provider may bill the patient for the remaining balance. This is known as balanced billing.

Balanced billing can result in unexpected and sometimes substantial medical bills for patients, especially in emergency situations where they may not have control over the choice of healthcare providers. To address this issue and protect consumers, legislation such as the No Surprises Act has been enacted in the United States, limiting the circumstances under which balanced billing is allowed and establishing protections for patients against surprise medical bills.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

No Surprises Act:

• Coverage and Billing: The No Surprises Act addresses situations where patients may receive out-of-network services, such as in emergencies or when they unknowingly receive care from an out-of-network provider within an in-network facility.
• Emergency Services: If your occupational therapy services are provided in an emergency setting, the No Surprises Act prohibits surprise billing. Patients are protected from being billed at out-of-network rates for emergency services.
• Transparency Requirements: The Act also includes transparency requirements, emphasizing the importance of providing patients with clear and detailed information about the expected costs of healthcare services. This is in line with the broader goal of ensuring transparency in healthcare pricing.

For more information visit https://www.cms.gov/medical-bill-rights or call the No Surprises Help Desk at 800-985-3059.