No Surprises Act

Your Billing Rights Under Federal and Virginia Law

Understanding Good Faith Estimates

Federal law requires healthcare providers to provide cost estimates to uninsured patients before treatment.

Your Right to Know Costs in Advance

You are entitled to receive a Good Faith Estimate that outlines the expected total cost of your healthcare services. This estimate covers all reasonably anticipated expenses, including consultations, tests, medications, equipment, and facility charges.

Timeline for Receiving Your Estimate

• Appointments scheduled 3+ business days ahead: Your provider must deliver a written estimate within 1 business day of scheduling
• Appointments scheduled 10+ business days ahead: Your provider must deliver a written estimate within 3 business days of scheduling
• Estimates requested without scheduling: Your provider must provide a written estimate within 3 business days of your request

Your Rights if Costs Exceed the Estimate

If your final bill exceeds the Good Faith Estimate by $400 or more, you have the right to dispute the charges. Always retain copies of both your estimate and final bill for your records.

Questions? Contact 1-800-985-3059, email FederalPPDRQuestions@cms.hhs.gov, or visit www.cms.gov/nosurprises/consumers

Protection Against Surprise Medical Bills

Understanding Balance Billing:

When receiving healthcare, you typically pay certain out-of-pocket expenses such as copayments, coinsurance, or deductibles. However, costs can increase significantly if you receive care from providers or facilities outside your insurance network.

Out-of-network providers have not contracted with your insurance plan. These providers may bill you for the difference between your plan’s payment and their full charge—a practice known as “balance billing.” These additional costs often exceed in-network rates and may not apply toward your deductible or annual out-of-pocket maximum.

Surprise billing occurs when you receive unexpected balance bills for care where you had limited control over provider selection—such as emergency situations or when out-of-network providers treat you at in-network facilities.

Federal Protections Against Balance Billing: You are protected in these situations

Emergency Care

When you receive emergency treatment for an urgent medical condition from out-of-network providers or facilities, your maximum liability is limited to your plan’s in-network cost-sharing (copays, coinsurance, deductibles). Balance billing is prohibited for emergency services, including post-stabilization care, unless you provide written consent to waive these protections.

Services at In-Network Facilities

When receiving care at in-network hospitals or ambulatory surgical centers, some providers may be out-of-network. However, your cost-sharing is limited to in-network amounts for these services: emergency medicine, anesthesiology, pathology, radiology, laboratory services, neonatology, assistant surgeons, hospitalists, or intensivists.

These providers cannot balance bill you or request that you waive your protections.

For other services at in-network facilities, out-of-network providers cannot balance bill you unless you provide written consent.

Important: You are never obligated to waive balance billing protections or receive out-of-network care. You can always select in-network providers.

Your Financial Protections:

When balance billing is prohibited, you only pay what you would have paid for in-network care (copayments, coinsurance, deductibles). Your insurance plan pays the remaining costs directly to providers.

Your health plan must:

• Cover emergency services without prior authorization
• Cover emergency care from out-of-network providers
• Calculate your cost-sharing based on in-network rates
• Apply payments for emergency and out-of-network services toward your in-network deductible and out-of-pocket maximum

Virginia State Balance Billing Protections

Virginia law (Virginia Code § 38.2-3445) provides additional protections against balance billing for emergency services and certain non-emergency services received within the state.

Consumers covered under (i) a fully-insured policy issued in Virginia, (ii) the Virginia state employee health benefit plan, or (iii) a self-funded group that opted-in to the Virginia protections are also protected from balance billing under Virginia law.

Virginia Resources

Virginia State Corporation Commission, Bureau of Insurance

• Phone: 1-877-310-6560 or (804) 371-9741
• Website: scc.virginia.gov/pages/BalanceBilling-Protection

Visit scc.virginia.gov/pages/BalanceBilling-Protection for more information about your rights under Virginia law.

How to Report Billing Concerns

If you believe you have been billed incorrectly or have questions about your charges, please contact any of the following resources:

Collaborative Care Psychiatry, LLC

• Address: 5700 Old Richmond Ave, Suite A-1, Richmond, VA 23226
• Phone: (804) 416-5226
• Email: info@collabpsych.care

Federal Resources

• No Surprises Help Desk: 1-800-985-3059
• Website: www.cms.gov/nosurprises/consumers

Virginia Resources

• Virginia Bureau of Insurance: 1-877-310-6560 or (804) 371-9741
• Website: scc.virginia.gov/pages/BalanceBilling-Protection