FEDERAL LAW EFFECTIVE JANUARY 1, 2022: Federal No Surprises Act / Good Faith Estimate

From APA: “Beginning January 1, 2022, psychologists and other health care providers will be required by law to give uninsured and self-pay patients a good faith estimate of costs for services that they offer, when scheduling care or when the patient requests an estimate…..The information provided in the good faith estimate is only an estimate, and the actual items, services, or charges may differ from what is included in the good faith estimate. However, uninsured or self-pay individuals may challenge a bill from a provider through a new patient-provider dispute resolution process if the billed charges substantially exceed the expected charges in the good faith estimate. Substantially exceeds means an amount that is at least $400 more than the expected charges listed on the good faith estimate for a specific provider.” 

Please see details and FAQ’s from APA here.

STATE LAW DISCLOSURE REQUIREMENTS POSTPONED UNTIL January 1, 2025: Massachusetts Patients First disclosure requirements:

This law requires health care providers to tell patients how much they (patients) will pay for planned hospital stays, medical procedures, health care services, and referrals – based on the patient’s specific health insurance plan.  Other disclosures are also required; for details, please see the Notice to Providers on Patients First law (G.L. c. 111, s. 228) available through the link below.

These requirements authorize the Massachusetts Department of Public Health (MDPH) to fine providers who fail to comply with a penalty up to $2,500 for each instance of non-compliance. Additionally, for private pay clients, the state indicates that “providers who fail to provide such notice are prohibited from billing the insured beyond any applicable copayment, coinsurance, or deductible that would be payable if the insured received the service from a provider who participates in the patient’s health plan.”

Requirements apply to services provided / billed through insurance coverage and those provided through private pay.

Please read the specifics here, where you will find a Notice for Patients and one for Providers that detail what we need to disclose. This law will not be implemented until January 1, 2025.