No Surprises Act

Dear Current And Potential Future Patients and Families,

Congress enacted a “No Surprises Act” which went into effect 1/1/2022. The act is described as new federal protections against surprise medical bills. Surprise medical bills happen when insured consumers accidentally receive care from out-of-network hospitals, doctors, or other providers they did not choose (please see https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/).

It is very unlikely this could affect our work together. There will be no situation in which you would accidentally receive care from us or with no choice. The federal government has not yet finalized the rules for how to do this in a small group practice like ours. 

We are “out of network” for all but certain BCBS plans (State Health Plan, PPO plans, and Federal plans). These plans provide protections for you, including the fact that we can never accept more than the amount they allow. If you have one of these plans, you should contact your insurer to ask about how much you would have to pay, what’s covered under your plan, and provider options. Sometimes, after your claims are processed, we may learn that more money is due (e.g., when a deductible has not been met, an increase in co-pay). When this happens, we only collect the amount that your insurance company charges for the service when provided by in-network providers. If you have questions about how much is due for services, you should contact  your insurance company. You may read more about this at https://www.cms.gov/nosurprises.

If we currently work together, you are already aware of our charges and your costs. Sometimes, insurance plans have changes that happen at the beginning of the calendar year or enrollment period. You should check with your insurance plan to get updates about any changes, such as the amount of your deductible or co-pay. 

If you are thinking about working with us, we will provide you with information about the costs for services. Before we meet, we have to provide your child with a diagnosis. Also, we have to give you information about the number of sessions and costs. This will be hard to do without knowing your child and family, but we will provide a good faith estimate of our services and costs. For now, the details of the law and how it applies to small group private practices continues to develop.

We will be as clear as possible with you about the costs of the services we agree on together. You will have “no surprises” here. You can ask us about any costs about which you may be unsure, and we will give you clear information.

Please feel free to contact us if you have any questions. Our contact information can be found under the CONTACT menu on this website.