Good Faith Estimate
Client Rights Under the No Surprises Act
No Surprises Act & Good Faith Estimate
The No Surprises Act was enacted on December 14th, 2020 which is intended to reduce unexpected medical bills for patients. This bill began as a protection effort for patients in order to prevent surprise large bills from healthcare agencies such as hospitals or group practices. This is an important and much needed protection as historically patients would pursue voluntarily or require emergency medical care only to find that although the agency was in network there was a portion of services provided that was out of network, ultimately resulting in unexpected, large medical bills.
Mental health practitioners already have strong ethical standards requiring us to inform our clients of fees before commencing treatment. Additionally, there is an ethical responsibility to clarify and inform all clients that if the client has insurance then that client has the option to seek a provider within your network at a lower fee or use a superbill to get partial reimbursement, if your plan allows. These are now requirements for all health care providers.
At Birch Tree Counseling LLC we believe that it is important that all clients understand this new law and its implications to their current and future medical care; and that clients have the right to receive a “Good Faith Estimate” explaining how much their medical care will cost. This estimate and clearly outlined information is crucial to the client’s informed consent and decision making with emphasis to individuals that do not have insurance, are not using insurance or are receiving services from an Out of Network provider.
Client Rights Under New Legislation
Under this new law, healthcare practitioners need to provide patients who do not have insurance or are not using insurance with an estimate of the bill for medical items and services.
Additional Clarification of Client Rights:
1.) Clients have the right to receive a Good Faith Estimate for the total expected cost of any non emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
2.) Clients have the right to ask for the Good Faith Estimate to be in writing at least one business day before the medical service is scheduled or item is ordered/purchased. It is also permitted to ask your healthcare provider for a Good Faith Estimate prior to scheduling an item or service.
3.) Clients have the right to dispute a bill that is at least $400 more than the Good Faith Estimate.
Psychotherapy Services & The No Surprises Act
There is a clear and notable difference between pursuing a medical procedure, equipment, or emergency medical service and psychotherapy services. Under this new law it is expected that the Good Faith Estimate contain a diagnosis with the estimate of fees, and a specified length of treatment. This is understandable and applicable to medical procedures but there are some challenges to this with psychotherapy. Below outlines the differences and the ethical and legal efforts to incorporate these requirements of this new legislation.
Additional Clarification for Psychotherapy Services and Good Faith Estimates:
1.) Based on the ethical standards outlined through the licensing boards for clinicians there is not to be an identified diagnosis prior to fully assessing the client which cannot be performed prior to meeting them. And in some cases the assessment phase lasts longer than just the first initial session.
2.) The length of treatment varies from client to client depending on the nature of therapy need, variables of life stressors and events, as well as unexpected life events that arise during therapy. Upon the initial consultation prior to assessment and engaging in therapy work the clinician is unable to establish a specific and concrete timeline. It is possible to communicate what is “reasonably expected” within the Good Faith Estimate which may look like for example, weekly appointments for approximately 8-12 weeks is recommended with an assessment of treatment plan progress and determination of next steps in frequency of treatment at the 12-week mark. This may be more clear and concrete if the therapy service being pursued is an established group therapy service, intensive therapy program, or time limited therapy model.
3.). The one constant that counselors rely on is that the lives of clients are fluid and always changing. Life is unpredictable therefore the estimated length of treatment, frequency of services, and the need for additional clinical services or items for supplementing treatment may not be reflected in the Good Faith Estimate.
What Can You Expect from Birch Tree Counseling LLC’s Good Faith Estimate?
Birch Tree Counseling LLC is dedicated to transparency in the therapy relationship and has prided itself on having clear and explicit policies, service fees, and accessible and dependable communication with your counselor. This legislation is not something that is different from the high standard of care you have come to expect from Birch Tree Counseling LLC. It has only changed in the fact that the clients have a right to obtain a Good Faith Estimate for services and that it is outlined in writing. This Good Faith Estimate will be provided to new and existing clients to ensure comfort and confidence in the services provided and the fees charged.
What can you expect to find on the Good Faith Estimate?
1.) Demographic information for the client ie: Name and Date of Birth.
2.) A description of the psychotherapy services or additional services expected to be provided including but not limited to: Initial diagnostic assessment session; ongoing 60min, 45min, or 30min psychotherapy sessions with their CPT codes for insurance reimbursement or coverage; and reasonably expected additional services that may occur ie: documentation completion- provider/work letters, FMLA paperwork; etc.
3.) The name of the counselor, name of the practice, National Provider Identifier, Tax Identification Number, office location or telehealth specifier for where services will be provided.
4.). The acknowledgement that there may be additional clinical services or items that are recommended as part of the treatment which may not included at the time of the Good Faith Estimate.
5.) The acknowledgment that requesting a Good Faith Estimate from this practice and clinician does not require the client to obtain services from this practice. Birch Counseling LLC respects self-determination, informed consent, and decision making that is right for the client and their financial needs.