No Surprises Act

Important Notice – Your Rights Under the No Surprises Act

Balance Billing Protections

Texas and federal law protect you from certain unexpected medical bills. While Desta Therapy does not provide emergency or hospital-based care, we want you to be aware of your rights:

• Emergency care – If you ever receive emergency services from a hospital or facility, you cannot be billed more than what you would pay if the provider were in-network.

• Out-of-network care at in-network facilities – This generally applies to hospital or surgical settings (e.g., anesthesia, radiology). Since Desta Therapy is an outpatient counseling practice, this is unlikely to apply to your care here.

Good Faith Estimates for Self-Pay or Uninsured Clients

If you are uninsured or choose to pay for therapy out-of-pocket, you have the right to receive a Good Faith Estimate (GFE) of expected charges before services are provided.

• You can request a GFE at any time before scheduling therapy.

• Desta Therapy will provide your estimate in writing (paper or electronic) within the timeframes required by law.

• If your bill is $400 or more above the estimate, you may be able to dispute the charge.

Need Help or Have Concerns?

Contact:

• Federal: Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE or visit cms.gov/nosurprises

• Texas State: Texas Department of Insurance, Consumer Help Line at 1-800-252-3439 or visit tdi.texas.gov (search “surprise billing”)