Introduction to the No Surprises Act (H.R. 133) 

The No Surprises Act aims to increase price transparency and reduce the likelihood that clients receive a “surprise” medical bill by requiring that providers inform clients of an expected charge for a service before the service is provided.  Starting January 1, 2022, behavioral health care providers will be required by law to give uninsured and self-pay clients a good faith estimate of costs for services when scheduling care or when the client requests an estimate (whichever occurs 1st).

Prior to the implementation of the No Surprises Act, all psychotherapists already had/have an ethical obligation to provide advance notice of costs and fees for every patient.  The No Surprises Act builds off of that and asks the private practice practitioner to provide further formal disclosures of anticipated fees.  This consumer protection legislation is aligned with  ACA & AAMFT professional ethics regarding the duty to promote client welfare and protect against potential harm. Both the ACA & AAMFT code of ethics stipulate that providers must inform their clients about fees and billing practices, in accordance with the above.

What is a Good Faith Estimate?

https://omb.report/icr/202109-0938-015/doc/original/115257801.pdf

All non-insured or self-paying individuals must be provided with a Good Faith Estimate.  The regulation allows clients to waive some of the protections related to balance billing, but does not allow providers to bypass the Good Faith Estimate through a client waiver.  Provider will ask current/new client(s) whether they have any health insurance coverage that they intend to use for covering services.  Provider will furnish a “Right to Receive a Good Faith Estimate of Expected Charges” to the client.  Please see link below:

https://omb.report/icr/202109-0938-015/doc/original/115257801.pdf

Disclaimer

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, and does not include any unknown or unexpected costs that may arise during treatment.

Throughout your treatment, the MPC, LLC may recommend additional items or services as part of your treatment that are not reflected in this estimate. These would need to be scheduled separately with your consent and the understanding that any additional service costs are in addition to the Good Faith Estimate.

If your needs/rates change during treatment, MPC,LLC will supply a new, updated Good Faith Estimate to reflect the changes to treatment, and the accompanying cost changes.

Please note that you as the client have the right to initiate the client-provider dispute resolution process if the actual billed charges are substantially in excess of the expected charges included in the Good Faith Estimate(s).  Please contact your provider directly, or your provider’s Clinical Supervisor, Shannon L. Doherty, LMFT & AAMFT Approved Supervisor with questions or concerns about a bill received.  You may also call HHS at (800) 368-1019, or access the link below for additional dispute process information:

https://www.cms.gov/nosurprises/consumers

Additional Fee Disclosure

 In accordance with the OCR & SAMHSA, HIPAA Compliance Updates, & the 2021 Inflation Adjustment & HITECH Act, all clients of Miriam Porat Counseling, LLC, will be invoiced a $100/prorated hour, for any PHI summaries, copies, and/or deliveries requested.