“No Surprises” Act
Effective January 1, 2022, laws regulating client care have been updated to include the “No Surprises” act, which requires a wide variety of providers to give current and potential future clients a “Good Faith Estimate” (GFE) on the cost of treatment. Below you will find a summary of this requirement.
Effective January 1, 2022, a 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 patient?
A provider’s duty to provide notice and a GFE applies to self-pay patients, i.e., an individual who (1) does not have 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 benefits plan; or (2) chooses not to use his or her coverage benefit for the item or service.
In many ways, this regulation protects patients from discovering, after they receive care, that they owe a massive medical bill for un-covered services. This makes sense from a medical point of view – we have all heard the horror stories of a patient going bankrupt after discovering their insurance doesn’t cover some services or providers. For example, if an out-of-network provider gives post-surgical care at an in-network hospital, the patient could end up with a big out-of-pocket expense that comes as a complete surprise.
However, therapy is a little different in that we can’t necessarily provide an estimate of how long it takes to treat a relationship issue, address anxiety, make a plan for parenting, focus on and minimize depression, etc. There are a number of variables that make it nearly impossible to quantify what will be needed. And there is no way to give a “good faith estimate” on whether or not a client will want to return for a “tune-up”
I have made several attempts to get clarification on how this affects therapists and therapy clients and been unsuccessful. In an abundance of caution and in keeping with my policies of general transparency, I am posting this notice.
Good Faith Estimate Details
Below reflects current session fees, projected over variable levels of use for any 12 month period. Established clients have already completed their intake appointments and can disregard the fee for that service. New clients are required to begin with a 90 minute intake appointment.
Individual Client: Good Faith Estimate
Intake appointment $265
Follow up (55 min) sessions $175
Client sees therapist weekly for 50 weeks in calendar year $8840
Client sees therapist every other week for 50 weeks $4640
Client sees therapist every 4 weeks for 50 weeks $2365
Couple/Family clients: Good Faith Estimate
Intake appointment $265
Follow up (90 min) sessions $265
Clients see therapist every week for 50 weeks $13250
Clients see therapist every other week for 50 weeks $ 6625
Clients see therapist every week for 50 weeks $ 3180
The frequency with which clients are seen, and the duration of time in which they are seen, is dependent on client need. The above examples are for illustrative purposes only and are not specific to you or your treatment. Instead they are meant to show the variation of cost over the course of a year
Leave a Reply