No Surprise Act

What Is Balance Billing?

 When you receive care from a health care provider or facility that is out of your insurance network, you may be responsible for             higher costs. This is called “balance billing.” It means you may be billed for the difference between what your insurance pays and       the full billed amount.

•  In-Network Services: If we are in-network with your insurance plan, you are only responsible for standard copays, deductibles, or coinsurance. Balance billing does not apply.

• Out-of-Network Services: If we are out-of-network, you may be responsible for additional costs beyond what your insurance covers. However, you still have the right to receive a Good Faith Estimate (GFE) of expected charges before services begin.

Services Not Covered by Insurance

    Some of the services we provide may not be covered by your insurance plan, either because:

• They are considered non-covered benefits (e.g., certain holistic or wellness services).

• You have reached benefit limits for therapy or counseling.

• Your plan does not include coverage for specific types of treatment. 

• If a service is not covered by insurance, you will be responsible for the full self-pay rate. A Good Faith Estimate will provide in advance, so you understand the expected cost.

Your Rights Under the No Surprises Act

• You have the right to receive a written Good Faith Estimate for the total expected charges of non-emergency services, whether in-network, out-of-network, or self-pay.

• You cannot be balance billed for emergency services or for certain services provided by out-of-network providers at in-network facilities, unless you knowingly consent in writing.

• If your bill is $400 or more above your Good Faith Estimate, you have the right to dispute the charge.

Dispute Process

If you receive a bill that seems incorrect or significantly higher than your Good Faith Estimate:

1. Contact us directly to review the charges.

2. You may request an official dispute resolution through the U.S. Department of Health and Human Services (HHS).

3. Learn more at: www.cms.gov/nosurprises.

To request a Good Faith Estimate, contact: lbailey@expressmindbodywellness.com