Your Rights Under the No Surprises Act

The No Surprises Act is a federal law that protects people from certain unexpected medical bills. It also gives individuals who do not have insurance—or who choose not to use insurance—the right to receive an estimate of their expected charges before receiving scheduled services.

Surprise Billing Protections

“Surprise billing” can occur when someone receives care from an out-of-network provider without knowingly choosing that provider. Federal protections primarily apply to:

• Emergency services received from an out-of-network provider or facility; and
• Certain services provided by out-of-network providers at an in-network hospital or ambulatory surgical center.

Kalamazoo Child & Family Counseling provides scheduled outpatient behavioral health services. We do not provide emergency medical services or provide services through a hospital or ambulatory surgical center. As a result, these federal balance-billing protections generally do not apply to services received directly from our practice.

Before beginning services, we encourage you to contact your insurance company to confirm:

• Whether KCFC and your assigned provider participate in your plan;
• Whether the requested service is covered;
• Whether authorization or a referral is required; and
• The deductible, copayment, or coinsurance you may owe.

Our staff will assist with insurance questions when possible, but your insurance company makes the final determination regarding eligibility, coverage, and benefits.

Good Faith Estimates

If you do not have health insurance or do not plan to use insurance to pay for your care, you have the right to receive a written Good Faith Estimate explaining the expected cost of your scheduled services.

You may also request a Good Faith Estimate before scheduling services. The estimate will be based on the information available at the time and may change if your clinical needs, recommended services, frequency of treatment, or length of treatment changes.

A Good Faith Estimate is not a contract and does not require you to receive services from KCFC.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may be eligible to use the federal patient-provider dispute resolution process. Disputes generally must be initiated within 120 calendar days of receiving the bill.

Learn more about Good Faith Estimates and the dispute process through the Centers for Medicare & Medicaid Services.

Questions or Concerns About Your Bill

If you have questions about an estimate, insurance claim, or bill from KCFC, please contact our office at 269-615-7637. We encourage you to contact us first so we can review the concern and work with you toward a resolution.

For additional information or to report a potential violation of federal surprise-billing protections, contact the No Surprises Help Desk at 800-985-3059 or visit CMS: Medical Bill Rights.

Michigan residents may also contact the Michigan Department of Insurance and Financial Services at 877-999-6442.