The Situation:  The federal No Surprises Act became law on January 1, 2022.  It addresses balance billing, out-of-network costs, and the right of uninsured or self-pay patients to receive a good faith estimate of scheduled, non-emergency healthcare services.  A healthcare provider must give a patient an estimate in writing within at least one day before a scheduled medical service where the service was scheduled at least three days in advance.  In addition, a patient can request a good faith estimate at any time.   The law also provides for a dispute resolution process.  What happens when a healthcare provider intends to see a patient on a regular basis throughout the year?

The Potential Issues:  Failure to comply with federal law.

The Solution:  This is an issue that can arise, particularly in the behavioral health arena.  A healthcare provider can still satisfy the law by providing a good faith estimate that explains the expected scope of the recurring services, such as timeframes, frequency, and total number of services.  Further, the good faith estimate should only address services over a 12-month period.  A new good faith estimate would need to be prepared for a subsequent 12-month period.  For example, the good faith estimate might address this issue by stating:  “I expect that you will receive therapy services from me every two weeks, at a cost of $100/session, resulting in a total cost for 12 months of $2,600.”  The good faith estimate has additional requirements which can be addressed by consulting a lawyer or the No Surprises Billing Act.