Kairoi Counseling – No Surprises Act Notice
Notice of Client Rights & Protections Against Surprise Medical Bills
You are protected from surprise billing or balance billing when you receive emergency care or treatment from an out-of-network provider at an in-network hospital or ambulatory surgical center.
What is “balance billing” (also called “surprise billing”)?
When you receive care, you may be responsible for copayments, coinsurance, or deductibles. If you see a provider or visit a facility that is not in your health plan’s network, you may have additional costs or be billed the full amount for services.
“Out-of-network” providers and facilities have not contracted with your health plan. They may bill you for the difference between the provider’s charge and what your plan agrees to pay—this is “balance billing.” These charges are usually higher than in-network rates and may not count toward your annual out-of-pocket limit.
“Surprise billing” occurs when you receive an unexpected balance bill, such as during emergencies or when you receive care at an in-network facility but are treated by an out-of-network provider without your knowledge.
You are protected from balance billing for:
Emergency Services:
If you experience a medical emergency and receive care from an out-of-network provider or facility, the most you can be billed is your in-network cost-sharing amount (copays, coinsurance, etc.). You cannot be balance billed for emergency services. This includes post-stabilization services unless you provide written consent to waive your protections.
Certain Services at an In-Network Hospital or Ambulatory Surgical Center:
Some providers at in-network facilities may be out-of-network. For specific specialties—emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgery, hospitalist, or intensivist services—you may only be billed your in-network cost-sharing amount. These providers cannot balance bill you or ask you to waive your protections.
For other services, out-of-network providers may only balance bill you if you give written consent and choose to waive your protections.
You are never required to waive your protections and may always choose in-network care.
When balance billing is not allowed, you are granted the following protections:
You are responsible only for in-network cost-sharing amounts.
Your health plan must pay out-of-network providers and facilities directly.
Emergency services must be covered without prior authorization requirements.
Your health plan must base your cost-sharing on in-network rates and list the amount in your Explanation of Benefits.
Any amount you pay for emergency or protected out-of-network services must count toward your deductible and out-of-pocket maximum.
If you believe you were wrongly billed:
You may contact the New Mexico Counseling and Therapy Practice Board
Email: counseling.board@rld.nm.gov
Address: PO Box 25101, Santa Fe, NM 87504
For more information about your Federal rights: