Good Faith Estimate
I have not received any direction from the New Jersey Division of Consumer Affairs regarding the implementation of the Good Faith Estimate (GFE) of expected charges for services provided with the No Surprises Act. This information is provided to you with the intention to be transparent.
In December 2020, Congress passed the No Surprises Act. It was intended to reduce unexpected medical bills for patients (as example: you have surgery that is covered by your insurance and then get a huge bill from the anesthesiologist, who turns out to be out-of-network for your plan).
This law went into effect January 1, 2022. New information about this law and requirements and how they relate to private practice psychotherapists just became widely available a few days before the law took effect. Our professional associations did not even realize the implications, and it seems that most of the thousands of therapists it affects across the country, myself included, are learning how to navigate this new act.
The basics of the requirements are already in place for almost all private practice therapists, as our professional associations have strong ethical standards requiring us to inform our clients of fees before commencing treatment, make it clear that, if you have insurance, you have the option to seek a provider within your network at a lower fee, and allow clients who choose to work with someone out-of-network to receive a “superbill” which can be submitted for possible partial reimbursement. Superbills also contain diagnostic codes, which are another requirement of this new bill.
Some requirements of this new legislation are expanded from the above. According to this law, we are directed to provide a diagnosis before commencing treatment (in direct contradiction with the ethical standards of our profession, which would never allow diagnosing someone without seeing them), and we are required to provide a Good Faith Estimate, to predict total costs in advance of treatment. This would make sense for something like setting a broken bone. However, psychotherapy does not generally work like that. We might have an idea what the trajectory of treatment for a particular issue will be, based on experiences with other clients, but we cannot know exactly what initially brings someone to see a therapist or what other concerns might arise during the course of treatment.
Therapy is self-determined. Length of treatment depends entirely on the client, their needs, and clients are allowed to stop at any time.
Implementation of this new law seems to be a gray area at the moment. There are contradictory interpretations of several aspects of it, and conflicting information about what needs to be done before March or December (two of the dates that come up in terms of requirements). There are also likely to be challenges to the inclusion of psychotherapists in the way this legislation was intended.
Living Well Counseling Center, LLC
GOOD FAITH ESTIMATE
For Health Care Items & Services
Effective January 1, 2022, a ruling went into effect called the “No Surprises Act” which requires practitioners to provide a “Good Faith Estimate” about out-of-network care.
Under Section 2799B-6 of the Public Health Service Act (PHSA), health care providers and health care facilities are required to inform individuals who are not enrolled in an insurance plan or Federal health care program, or not seeking to file a claim with their plan, that prior to service and upon request they are entitled to receive (both orally and in writing) a “Good Faith Estimate” of expected charges.
Note: The PHSA and GFE does not currently apply to clients who are using insurance benefits, including “out of network benefits” (i.e. submitting Superbills to insurance for reimbursement). However, I am furnishing this information to all clients so that you may understand your estimated charges in the event that your health insurance expires, or you choose to become a cash pay client. These charges would also apply if you received services after the expiration of your health insurance plan and did not give us prior notification of the expiration.
Good Faith Estimate Disclaimer
This Good Faith Estimate shows the costs of items and services that are reasonable 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.
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 are billed for more than this Good Faith Estimate, you have the right to 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 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. For questions, or to learn more, or to get a form to start the process, go to www.cms.gov/nosurprises or call 800 985-3059. Keep a copy of this Good Faith Estimate in a safe place.
While it is not possible for a psychotherapist to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of sessions you attend, your individual circumstances, and the type and amount of services that are provided to you. It is entirely possible that you may prefer shorter or longer sessions, and for that reason, various fees have been supplied to you. This GFE is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate I your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with your therapist. You are entitled to disagree with any recommendations made to you concerning your treatment, and you may discontinue treatment at any time. This estimate is not a contract and does not obligate you to obtain services from the provider listed, nor does it include any services rendered to you that are not identified here.