The "No Surprises Act" is a federal law that was recently passed into legislation, becoming effective as of 1/1/22. It requires that medical providers give a Good Faith Estimate for their services prior to working with a patient. This is specifically for patients who are either uninsured or have private health insurance and don't plan to file a claim (self-pay). 

The main idea is to prevent huge bills from piling up when a patient requires emergency medical care. For example: someone goes to the hospital to have their appendix removed. The surgeon is "in-network", meaning that they're covered under the person's insurance, but the anesthesiologist wasn't covered by their plan. A cost that should have been relatively manageable suddenly becomes thousands of dollars, all without the patient knowing ahead of time. 

I fully support what the Act aims to do in that regard; it is one of the principals that I built my own business on. The problem lies in the fact that it encompasses all healthcare professionals, "no exceptions". 

The small, out-of-network physical therapy practice that I created (Rise Above Physical Therapy, LLC) was built on the idea of working directly for my patients instead of their insurance company. This allows me to get my patients feeling better faster because our time and types of treatment are not dictated by what insurance will pay for. They pay out-of-pocket but are provided with a receipt following each session, which can then be brought to their insurance for reimbursement. 

The Good Faith Estimates we need to provide because of the No Surprises Act require us to provide a diagnosis code, total number of estimated visits, and a break down of how many units of each type of therapy the patient will need during each visit. This is required ALL BEFORE WE'VE SEEN THE PATIENT. The only way to accomplish this is to do the initial evaluation for free so that we have all the information we'd need for the estimate or just put our best guess before we've even seen them - I'm not sure where the benefit lies in this. I created my out-of-network practice to avoid these types of issues created by the system and now we've been roped back into it because of the lack of specificity in this Act. 

We are always transparent with our pricing and plan of care up front. Patients typically end up paying less than what we bill them due to insurance reimbursing them afterwards. On the other hand, we have consistently seen patients get surprise bills months after treatment when they've gone directly through their insurance for physical therapy. This happens because the insurance company looks through what the therapist billed them for and then decides which services will be covered. 

From both a provider and patient perspective, this seems to be the root of what the No Surprise Act should be preventing. Unfortunately, the Act doesn't address that. 

To make matters worse, the penalty for each violation of this new law is a $10,000 fine. Once again, this makes sense for a practice such as a hospital but many of us out-of-network PTs are self-employed, small businesses. A fine of this stature could potentially put an end to a business of our size. 

The impact on this Act may seem insignificant to some but these are the small issues that contribute to this misuse of our valuable time and resources, which we are trying to use to improve people's lives and well-being. 

Please help us amend the "No Surprise Act" and "Good Faith Estimates".  This is a very important and valuable law when applied to the correct parties.  

This petition can be signed by Physical Therapists, patients who have experienced these circumstances, or anyone else in support of amending the No Surprise Act.

Michael Loebelenz PT, DPT

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