No Surprise Act
Starting January 1, 2022, laws regulating client care have been updated by the Federal Government to include the “No Surprises” act, which requires health care providers to give current and potential future clients a “Good Faith Estimate” (GFE) on the cost of medical or other healthcare treatment.
Starting January 1, 2022, a health care provider must furnish a self-pay patient with the notice and GFE prior to all scheduled services or by request if the patient is shopping for care (and not yet at the point of scheduling). This includes, but is not limited to, office visits, therapy, diagnostic tests, infusions, and surgeries.
Who Qualifies as a Self-Pay Client?
A provider’s duty to provide notice and a GFE applies to self-pay patients, e.g., an individual who:
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Does not have insurance benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, federal healthcare program, or a health benefit plan;
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Chooses not to use his or her coverage benefit for the item or service.
In a lot of ways, this new law is very helpful and forward thinking as it protects medical patients from discovering, after they receive care, that they owe a large medical bill for un-covered services.
This makes sense from a medical or physical health point of view. There have been stories of a patients going bankrupt after finding out that their insurance doesn’t cover some services or providers. For example, if an out-of-network provider gives care at an in-network hospital, the medical patient could end up with a large and excessive out-of-pocket expense that comes as a total surprise.
However, therapy is a little different in that we can’t necessarily provide an estimate of how long it takes to treat anxiety, social anxiety, panic attacks, depression, ADHD/ADD, trauma, PTSD, marriage counseling, family conflict, or other challenges.
There are a number of factors that make it nearly impossible to quantify what will be needed in a mental healthcare setting. And there is no way to foresee and give a “good faith estimate” on whether or not a client will want to return for a “tune-up”
While this new Federal Law largely applies to medical health providers, as mental health providers, we are also required to implement this law. In attempts to seek specifics on how this law is applied to quantifiable treatments, like medical treatments, compared to unquantifiable treatments, like mental health care, I’ve been unable at this point, to get clarification.
As a practice, we have always practiced transparency on the cost of treatment. Our rates are on our website for each therapist and service. Our rates are also on our FAQ page. We review the rates during the first, initial phone call and our rates are also in our “Consent, Policies, & Agreement” form we send to new clients.
Your Right to a Good Faith Estimate
Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, visit www.cms.gov/nosurprises.