In compliance with the No Surprises Act, in effect January 1st, 2022, we are required to notify clients of their Federal rights and protections against surprise billing.
These rights are also outlined at www.cms.gov/nosurprises/ and at www.cms.gov/nosurprises/consumers/new-protections-for-you.
You are under no obligation to sign a Good Faith Estimate but we may need to decline treatment if we do not sign an agreement.
The following section is intended to provide relevant and contextual information about the application of the No Surprise Act and subsequent Good Faith Estimates (GFE) to the field of psychotherapy.
Psychotherapists [broad term for: Licensed Clinical Marriage and Family Therapists, Licensed Clinical Professional Counselors, Licensed Clinical Social Worker Certified] in private practice were under the impression that the No Surprise Act would primarily protect patients from getting surprise and burdensome medical bills such as from the hospital. However, the Act does apply to the field of mental health. Therefore, relevant contextual information is necessary.
Providing a Good Faith Estimate to a clients’ mental health journey is partially unrealistic. Providing a per session fee is reasonable and already ethically required. A clients’ openness to the therapeutic process, speed of response to treatment, severity of condition, changing client goals, healthcare philosophy, value of ongoing support, frequency of treatment, and more all effect the cost of treatment. Psychotherapy is not a one-time procedure like a broken arm that can be easily quoted — and somatic medical procedures were what the Act originally aimed to apply to.
Under certain circumstances of the No Surprises Act, clients can enter a dispute resolution process if costs go too high above the Good Faith Estimate (GFE). Therefore, we need to quote a GFE for an entire year with the highest likely costs factored in. While this has the advantage of helping clients think through and budget for longer-term therapy, it can also force sticker shock on potential clients right at the time when they are most in need — possibly causing them to forgo the help they deserve.
To be clear, many/most clients see relief of their original condition/concerns far faster than a year, and if they stay that long it is because they are finding value working on secondary or different concerns. Clients always have the right to discontinue therapy at any time they are worried about their budget, or discuss budgeting options with their therapist.
Most people do not think of their budgets or financial lifestyle choices in terms of a year. If you add up what a year of rent, food, or car payments cost, you would also likely be in for sticker shock. And, if you do not think of therapy as an essential expense, then you could add up a year of streaming services, concert/sporting event tickets, etc.
As a practice we support a clients’ decision to work with the provider and practice that is the best fit for them and their goals. At times, providers who accept insurance are the best fit and we are happy to provide referrals to our colleagues in the community if that is the clients’ preference. However, there is often an implicit assumption that clients seeing a therapist outside of insurance are being ripped off financially. We believe that sometimes the right provider is not in-network with a client’s insurance. For example, sometimes people want more data privacy than can be assured when insurance is involved. Also, sometimes, particularly in mental health, clients would like to work with a provider who will not be restricted by insurances dictating: diagnoses, treatment timelines (e.g., session length and frequency), modality requirements, etc.
Clients paying out-of-pocket for therapy will be given a GFE based upon our Standard Fee Schedule. Financial discounts are available on a limited basis.
We invite you to consider the value of your mental health needs and the value of your provider preferences in seeking treatment. Therefore, please reflect on the Good Faith Estimate and available in-network insurance options with a discerning eye. Being an informed consumer is wise on your part.
You have a right to receive a “Good Faith Estimate” explaining how much your medical care will cost. The 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.
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 or services.
• You have a right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least one (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.
• You can also get the items or services described in this notice from providers who are in-network with your health plan.
• 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 information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (443)-371-3233.
The following is a detailed list of expected charges for [psychotherapy], scheduled for . The estimated costs are valid for 12 months from the date of the Good Faith Estimate, which can be officially provided to you by reaching out through our Contact Us page. The amount below is only an estimate; it isn’t an offer or contract for services. This estimate shows the estimated costs of the items or services listed. It does not include any information about what your health plan may cover. The estimated cost does not factor in other fees. While they are listed for your reference, “other fees” will be discussed with you before charges are incurred.
• CPT 90791 (Initial Evaluation): $180-200
• CPT 90837 (53 to 60 minutes psychotherapy): $150-160
• CPT 90834 (38 to 52 minutes psychotherapy): $150-160
• CPT 90847 (psychotherapy with family member participating): $150-160
If you are paying out-of-pocket, the fees to see one of our therapists are as follows:
• Late Cancellation Fee: $160 (A late cancellation is a no-show or cancellation under 24 hours from the scheduled start time of a session for any reason be. This may also be charged if a client is more than 15 minutes late for an appointment.)
• Written Reports & Paperwork (when I agree to write them): $160/hour
• Legal and Court Fees: $200 per hour plus expenses. $1600 retainer in advance for days I am expected in court. Court hours (including travel time) billed in minimum blocks of 4 hours ($800) each. (I will rarely agree to voluntarily participate in legal/court matters.)
• Weekly ($160/48 weeks): $7680
• Bi-weekly ($160/24 weeks): $3840
• Monthly ($160/12 months): $1920
The majority of clients seen at Wellness & Co. attend therapy on a weekly, bi-weekly, or monthly basis.
Therefore, based on the schedule of fees provided (maximum $160/50 minute session) and a variety of applicable factors [sick time, vacation time, frequency of sessions, etc.] A Good Faith Estimate of total cost of services provided is:
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