No Surprises Act:
Information for Self-Pay Patients at Encourage Speech and Voice Therapy, PLLC
The No Surprises Act, effective January 01, 2022, is a federal law designed to protect patients from unexpected medical bills, particularly those resulting from out-of-network care. While the law mainly targets emergency care and in-network facilities such as hospitals, some of its provisions may also apply to speech/voice therapists who do not accept insurance.
Our Practice
At Encourage Speech and Voice Therapy, PLLC (“we”, “us”, “our”), we define a patient as a person receiving speech/voice therapy services due to a diagnosis of a speech/voice disorder. We define a client as a person receiving training, educational, or other elective services in the absence of a speech/voice disorder. The No Surprises Act applies to patients.
At our practice, all patients must pay for services on a self-pay basis. We do not have any direct involvement with insurance claims whatsoever. Upon patient request, we will provide you with a superbill (i.e., detailed receipt of services). The patient may submit the superbill to their insurance company to seek reimbursement for out-of-network services. The insurance company may reimburse the patient for a portion of the self-pay fees paid for services. However, reimbursement is not guaranteed. Therefore, all patients must be prepared for the financial responsibility of receiving services at our practice. The No Surprises Act allows us to help patients prepare as follows.
Good Faith Estimate Requirement
As a non-participating provider (one who does not accept insurance), the No Surprises Act requires us to provide patients with a Good Faith Estimate (GFE) of the expected cost of a service. Patients can request a GFE before scheduling a service and must be provided with one after scheduling a service. Your provider will give you a list of services associated with your care and the expected charges. If you receive a bill that is at least $400 more than your GFE, you can initiate an arbitration procedure to dispute the bill.
Exclusions
If a patient knowingly chooses to receive care from an out-of-network provider in a non-emergency scenario (e.g., choosing a therapist outside their insurance network for personal reasons), the protections of the No Surprises Act may not apply.
Documentation of Communications
We will document all communications we have with our patients regarding self-pay fees and cost estimates.