No Surprise Act and Good Faith Estimates
Starting in 2022, the No Surprises Act gives clients more control and clarity around healthcare costs. If you are paying for therapy without using insurance, you are entitled to a Good Faith Estimate—a written document that outlines the expected cost of your services before you begin. This estimate is designed to help you: Understand the likely costs of therapy in advance. Avoid unexpected or “surprise” bills. Make informed choices about your care. In my practice, I provide Good Faith Estimates to all clients who pay out of pocket. While the actual cost may vary based on the number of sessions or changes in your treatment plan, the estimate gives you a clear picture of what to expect financially.
Standard Notice of Your Right to a Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You 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. Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. 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, visit www.cms.gov/nosurprises
Insurance Rules, Coverage and Confidentiality
When it comes to insurance coverage for any therapy it's important to understand that insurance companies require a diagnosable mental health condition on file to establish the medical necessity for therapy services. In order to have therapy sessions covered, a mental health diagnosis will need to be provided to the insurance company if one is present. This will be assessed for in the initial session.
If you want to use your insurance coverage, it's important to understand that health insurance companies require not only a diagnosable condition but also regular documentation of medical necessity, which includes progress notes from therapy sessions.
In some instances, insurance companies may conduct audits to review these notes and ensure that the treatment is aligned with the diagnosed condition and continues to meet medical necessity criteria.
These audits may include reviewing progress notes from each session, so it's important to be aware that any diagnosis and treatment information shared with your insurance plan could be subject to such reviews.
If you are concerned about privacy and do not want to use your health insurance, there are options to pay for therapy out-of-pocket, and I can discuss sliding scale or payment plan options with you as well.
I strive to maintain your privacy and confidentiality, ensuring that your experience in therapy remains both professional and secure. If you have any questions about insurance coverage or the information that will be shared with your insurer, feel free to reach out, and I will be happy to provide further clarification.