The No Surprises Act

Understanding your protections against surprise medical bills, and how those protections apply to outpatient behavioral health care at STX Therapy.

Informational only. Last reviewed: August 2026

Why This Page Exists

Cost should never be the reason a person avoids asking for help. The federal No Surprises Act, which took effect on January 1, 2022, was written to protect people from unexpected medical bills and to make health care pricing easier to understand before care begins.

This page explains those protections in plain language, describes how they relate to outpatient behavioral health services, and tells you where to go if you believe your rights have not been honored. It is educational information, not legal advice, and it does not replace the specific terms of your health plan or the financial agreements you sign with STX Therapy.

What Surprise Billing Is

A surprise bill is a bill you did not expect and could not reasonably have anticipated. It usually happens in one of two ways.

The first is balance billing. When you see a provider who is outside your health plan's network, that provider may bill you for the difference between what they charge and what your plan agrees to pay. This difference is called a balance bill, and it is often much larger than an in-network copayment or coinsurance amount.

The second is unknowing out-of-network care. This happens when you go to a facility that participates in your plan but are treated by a clinician who does not, or when you receive emergency care and have no realistic ability to choose who treats you.

In both situations, the person receiving care is the least able to prevent the cost, and the No Surprises Act shifts that burden away from the patient.

Your Protections Against Balance Billing

Under federal law, you are protected from balance billing in the following circumstances.

You are protected in an emergency. When you receive emergency services from an out-of-network provider or facility, the most you can be billed is the in-network cost-sharing amount under your plan, including copayments, coinsurance, and deductibles. You cannot be balance billed for those emergency services, and this protection continues during post-stabilization care until you are able to safely travel or be transferred and have given informed written consent to out-of-network care.

You are protected for certain services at in-network facilities. When you receive care at an in-network hospital or ambulatory surgical center, certain providers there may be out of network. For those services, you cannot be balance billed, and you cannot be asked to give up your protections for emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services.

When these protections apply, your health plan must count what you pay toward your in-network deductible and out-of-pocket limit, must base payment on a recognized amount rather than the provider's full charge, and must pay the provider directly. You are never required to give up these protections, and you are never required to accept out-of-network care.

Emergency Care and Behavioral Health

If you are experiencing a mental health emergency, your first priority is safety, not billing. Call or text 988 to reach the Suicide and Crisis Lifeline, call 911, or go to the nearest emergency department. Federal protections for emergency services apply to emergency behavioral health and substance use care in the same way they apply to other emergency medical care.

STX Therapy does not provide emergency, crisis, or after-hours services, and messages sent through this website are not monitored for emergencies.

Texas Protections

Texas has its own surprise billing protections, established by Senate Bill 1264, which took effect on January 1, 2020. Texas law removes many patients from the middle of billing disputes entirely by requiring insurers and providers to resolve out-of-network payment disagreements between themselves, often through mediation or arbitration administered by the Texas Department of Insurance.

State protections generally apply to state-regulated health plans, including plans purchased through the Texas marketplace, Texas HMOs and preferred provider plans, and coverage for state and teacher retirement system participants. Federal protections under the No Surprises Act apply more broadly and cover many employer self-funded plans that state law cannot reach. Depending on the plan you carry, one or both sets of protections may apply to you.

How This Applies to Outpatient Behavioral Health

It is important to be accurate about scope. Most of the balance billing protections described above apply to emergency services and to care delivered at hospitals, hospital outpatient departments, ambulatory surgical centers, and similar facilities. Scheduled outpatient psychotherapy in a private practice setting is generally not the type of care that produces a surprise facility bill.

The part of the No Surprises Act that applies most directly to a practice like STX Therapy is the Good Faith Estimate requirement. If you are uninsured, or if you are insured but choose not to use your benefits, you have the right to receive a written estimate of the expected cost of your care before services begin.

STX Therapy is an outpatient behavioral health practice. Sessions are scheduled in advance, fees are disclosed before care begins, and you will always know what a session costs before you attend one. Our commitment is that no client of this practice should ever be surprised by a bill.

Good Faith Estimates

If you are uninsured or self-pay, you have the right to receive a Good Faith Estimate explaining how much your care will cost. Health care providers are required to give uninsured and self-pay clients an estimate of expected charges for services, including psychotherapy and related items.

You have the right to receive a Good Faith Estimate in writing at least one business day before your service, and you may ask for one at any time before scheduling. If you receive a bill that is at least four hundred dollars more than your Good Faith Estimate, you may dispute the bill through the federal patient-provider dispute resolution process.

Our dedicated Good Faith Estimate page explains this right in detail, including what the estimate contains, when you receive it, and how the dispute process works.

Our Transparency Commitment

STX Therapy discloses fees before your first appointment, provides a written Good Faith Estimate to uninsured and self-pay clients, explains cancellation and late-cancellation policies in advance, tells you clearly whether we participate with your health plan, and answers cost questions before you commit to care.

Insurance credentialing and contracting are in progress. Because network participation can change, please contact us to verify current network status, eligibility, benefits, deductibles, copayments, and any authorization requirements before your first appointment.

If You Believe You Have Been Wrongly Billed

Start with the party that issued the bill. Contact the provider's billing office or your health plan and ask for a written explanation. Many billing problems are clerical and are resolved at this step.

For federal protections, you may contact the No Surprises Help Desk operated by the Centers for Medicare and Medicaid Services at 1-800-985-3059, or visit cms.gov/nosurprises. Complaints about violations of federal balance billing protections are generally submitted within one hundred twenty days of receiving the bill.

For Texas protections, you may contact the Texas Department of Insurance Consumer Help Line at 1-800-252-3439, or visit tdi.texas.gov. The Texas Department of Insurance also administers the state mediation and arbitration process for surprise bills involving state-regulated plans.

For general information about your rights under federal law, visit cms.gov/nosurprises.

Questions About Cost at STX Therapy

We would rather answer a cost question early than have you carry uncertainty into treatment. If anything on this page is unclear, or if you want to understand what care is likely to cost in your situation, please reach out.

STX Therapy Co. PLLC San Antonio, Texas Email: contact@stxtherapy.com

This page is provided for general educational purposes and does not constitute legal, financial, or insurance advice. Federal and state requirements may change. This page is reviewed at least annually and updated as those requirements change.