Under the No Surprises Act (H.R. 133 - which went into effect January 1, 2022), health care providers need to give clients or patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.
- This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes (under the law/when applicable) related costs like medical tests, prescription drugs, equipment, and hospital fees.
- The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
- You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.
- There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
- Make sure your health care provider gives you a Good Faith Estimate within the following timeframes:
- If the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling;
- If the service is scheduled at least 10 business days before the appointment date, no later than three business days after the date of scheduling; or
- If the uninsured or self-pay patient requests a good faith estimate (without scheduling the service), no later than three business days after the date of the request. A new good faith estimate must be provided, within the specified timeframes if the patient reschedules the requested item or service.
Note: A Good Faith Estimate (GFE) is for your awareness only and is not a contract.
How my office is handling the No Surprises Act -All clients are given the fee structures prior to starting therapy. Since this is provided, and this new law is being rolled out now with anticipated changes to come in implementation, individualized GFE will not be given to individual clients unless requested.
Please let me know if you need a copy of my fee structure and /or would like to request a GFE.
Here is an example of a GFE for weekly, twice a week and bi-weekly (every other week psychotherapy sessions. These prices are after the initial 90 min. session ($370).
- Participating in weekly psychotherapy sessions: $185 per session for a total of 50 weeks, accounting for vacations and holidays for an estimated total of $9,250 per calendar year.
- Participating in twice a week therapy for a total of 100 sessions, accounting for vacations and holidays for an estimated total of $18,500 per calendar year.
- Participating in bi-weekly psychotherapy sessions:$185 per session for a total of 25 weeks, accounting for vacations and holidays for an estimated total of $4,625. per calendar year.
It is difficult to determine the length of treatment for mental health care, and each client has a right to decide how long they would like to participate in mental health care. I will work with you to determine how many sessions are needed to receive the greatest benefit based on your clinical concerns.