No Surprises Act & Good Faith Estimate Policy

Your Rights and Protections Against Surprise Medical Bills

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At Vita Healthcare PLLC, we are committed to transparency regarding the cost of services and protecting you from unexpected medical bills. The No Surprises Act, effective January 1, 2022, is a federal law designed to prevent surprise billing when you receive services from out-of-network providers under certain circumstances.

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Understanding Surprise Billing

When you seek care, especially in an emergency or when using an out-of-network provider, you may be charged more than you expected. Surprise billing occurs when you get an unexpected bill because the services were provided by an out-of-network provider, which may result in higher fees.

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Under the No Surprises Act, patients are protected from these unexpected costs under specific conditions, and healthcare providers are required to disclose estimated costs upfront.

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What Protections Do You Have?

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• Emergency Services

  You are protected from surprise billing for emergency services. This applies whether you receive care in-network or out-of-network, without prior approval (also known as prior authorization). You cannot be charged more than your in-network cost-sharing amount (such as copayments or coinsurance) for emergency services.

• Non-Emergency Services from Out-of-Network Providers at In-Network Facilities

  When you receive non-emergency services from an out-of-network provider at an in-network facility, you are protected from surprise billing. Providers cannot bill you more than your in-network cost-sharing amount, unless you provide written consent to waive your protections and accept additional out-of-network charges.

• Good Faith Estimate for Uninsured or Self-Pay Patients

  If you are uninsured or not using insurance, you have the right to receive a Good Faith Estimate for the expected cost of any non-emergency healthcare services, including mental health services. This estimate will include the total expected cost of services and any associated fees.

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Good Faith Estimate (GFE) for Uninsured and Self-Pay Patients

 

What Is a Good Faith Estimate?

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The Good Faith Estimate is a personalized estimate that provides details of the anticipated cost of healthcare services based on the information available at the time the estimate is made. This applies to individuals who are uninsured or choosing to pay out-of-pocket for their care.

• You have the right to receive a Good Faith Estimate at least 72 hours before your scheduled service, or upon request.

• The estimate will outline the total expected cost of services, including therapy sessions, consultations, and any other fees associated with your care.

• If the cost of your final bill exceeds the Good Faith Estimate by more than $400, you have the right to dispute the charges.

 

How to Request a Good Faith Estimate

 

To request a Good Faith Estimate, you may contact us directly. Upon request, we will provide you with a detailed estimate of services. You can reach us at:

 

Email: help@vitahealth.us
Phone: (915) 944-1706

 

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.

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Dispute Resolution

 

If you believe you have been wrongly billed, or if your final charges exceed your Good Faith Estimate by more than $400, you have the right to dispute the bill.

 

For more information about your rights under the No Surprises Act or to start the dispute process, you can visit CMS.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.

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Remember:

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• You are protected from surprise billing in certain situations, and you have the right to receive a Good Faith Estimate of costs for your care.

• Your use of our services indicates your understanding of your rights and protections under the No Surprises Act.