The No Surprises Act is a federal law that protects patients from many unexpected out-of-network medical bills, especially for emergency services and certain non-emergency care received at in-network hospitals, hospital outpatient departments, and ambulatory surgical centers. Behavioral health services can fall under these protections in some settings, but the law does not automatically apply to every rehab, residential treatment center, therapist, or outpatient behavioral health program.
What does the No Surprises Act protect against?
CMS explains that the law limits surprise billing for most emergency services, certain non-emergency services provided by out-of-network clinicians at in-network facilities, and air ambulance services. When the law applies, patient cost-sharing is generally limited to the in-network amount.
Does it apply to behavioral health emergencies?
Potentially, yes. If behavioral health crisis services meet the federal definition of emergency services and are provided in a covered emergency facility, the No Surprises Act protections can apply.
CMS guidance specifically notes that certain behavioral health crisis facilities can qualify as independent freestanding emergency departments if they meet the regulatory requirements.
Does it apply to residential addiction treatment?
Not automatically. A residential addiction treatment facility is not necessarily one of the facility types covered by the federal surprise-billing protections for non-emergency care. Patients should not assume that choosing an out-of-network residential rehab is protected from balance billing under the No Surprises Act.
How does the law apply to outpatient behavioral health care?
If non-emergency behavioral health services are provided at an in-network hospital, hospital outpatient department, or ambulatory surgical center by an out-of-network provider, the protections may apply depending on the service and circumstances.
Services delivered in a freestanding office or treatment setting may fall outside those specific surprise-billing protections.
What about people who are uninsured or not using insurance?
The No Surprises Act also created Good Faith Estimate protections for people who are uninsured or choosing not to use insurance. Covered providers and facilities generally must provide an estimate of expected charges when care is scheduled in advance or when the patient requests one.
Trinity has a separate guide on Good Faith Estimates for rehab costs.
Does the law eliminate all balance billing?
No. Balance billing can still occur in situations outside the law’s protections, especially when a patient knowingly chooses an out-of-network provider or facility that is not covered by the No Surprises Act rules.
See Trinity’s guide on balance billing in addiction treatment for more detail.
What should I ask before behavioral health treatment?
- Is the provider and facility in network with my exact plan?
- Is this service subject to the No Surprises Act?
- Could any clinician involved be out of network?
- Will I receive a Good Faith Estimate if I am self-pay?
- What balance-billing protections apply in this setting?
Frequently asked questions
Does the No Surprises Act make all rehab out-of-pocket costs predictable?
No. Deductibles, coinsurance, authorization rules, network status, and services outside the Act’s scope can still affect costs.
Does it apply to emergency psychiatric care?
It can, when the service meets the federal emergency-service requirements and is provided in a covered emergency setting.
Can I waive No Surprises Act protections?
In limited non-emergency circumstances, a provider may use a notice-and-consent process, but consent is restricted and is not allowed for many emergency or ancillary services.
Where can I file a complaint?
CMS operates a No Surprises Help Desk and complaint process for potential violations.
Sources
- CMS: Medical Bill Rights Under the No Surprises Act
- CMS: No Surprises Act Consumer Protections
- CMS: No Surprises Act Provider Requirements
This article provides general educational information and is not legal or insurance advice.