The No Surprises Act and Good Faith Estimates

What is the No Surprises Act?

Beginning January 1, 2022, the No Surprises Act (H.R. 133) will go into effect. The law includes new requirements for health care providers, facilities, health plans and insurers which are intended to prevent consumers (a.k.a. patients) from receiving unanticipated medical bills. The No Surprises Act resulted in changes to the Public Health Service Act that also apply to health care providers and facilities.

Part I of the regulations protects consumers with health plan coverage from surprise bills from out-of-network providers under limited circumstances related to emergency and non-emergency services at in-network facilities.

Part II of the no surprise billing regulations, published in October of 2021, requires all health care providers and health care facilities licensed, certified or approved by the state to provide good faith estimates of expected charges for services and items offered to uninsured and self-pay consumers.

Timeframes for Providing Good Faith Estimates:

Providers and facilities must meet the following deadlines for providing good faith estimates:

If the item or service is scheduled at least 10 business days in advance, the good faith estimate must be provided within three business days.

If the item or service is scheduled at least three business days in advance, the good faith estimate must be provided within one business day.

If the individual requests such information, the good faith estimate must be provided within three business days.

Note: No estimate is required if a service is scheduled less than three business days before the appointment.

What You Will Receive

You will receive a written Good Faith Estimate (GFE) that includes an estimate of services (type of therapy/estimate of frequency) and estimated costs for those services for a 12 month period.

Psychotherapy is unique in that it is not possible to predict how your personal therapeutic process will unfold until we get started; there are many factors that contribute to this and every person is unique and different. The following is information that will help you anticipate and plan the cost of your therapy with Babies, Kids, and Families.

All services at Babies, Kids, and Families are billable except scheduling communications that do not exceed 10 minutes.

The billable rate for services is $230 per 50 minute session. Sessions exceeding 60 minutes are billed at a prorated fee in 15 minute increments. Sessions may be scheduled for more or less time than a standard 50 minute session and are billable in 15 minute increments (a 30 minute session is billed at half of the full rate). No-shows and late cancelations are billable at the full fee.

You can calculate an estimate on your own by multiplying the billable rate of $195 ($230 as of 11/1/23) by the number of sessions you anticipate wanting/needing. The industry standard is weekly therapy however at times clients require/request multiple sessions in a week. Conversely, clients may titrate down to less than weekly sessions also.

At times, additional services requested/required, for example in times of stress or emergency, high conflict scheduling issues, collaboration with other professionals, or collaboration with other family members (for example in the case where a minor is the client there will be additional sessions with parents ranging from weekly to monthly depending on the minor’s age and therapeutic needs.)

High conflict parenting cases tend to see an increase in costs. Any clinical service, including phone calls, reading emails, court orders, etc., is billable at the standard rate in increments of 15 minutes. Any scheduling time exceeding 10 minutes is also billable.

Therapists at Babies, Kids, and Families do not appear in court. The Fees for court appearances and preparation for court, if subpoenaed, are higher than our standard rate.

Potential monthly/annual costs for therapy excluding additional services listed above (based on a 5 week month) at the rate of $230

Weekly therapy: Monthly – $1,150, Annually – $11,960

Twice weekly: Monthly – $2,300, Annually – $23,920

Twice a month: Monthly – $460, Annually – $5,520

Every other week: Monthly – $460-690,  Annually – $5980

Once monthly service: Monthly – $230, Annually – $2,760

Superbills and CPT Billing Codes

Some clients utilize superbills to help reduce the cost of out of pocket therapy. A superbill is a detailed receipt that includes a diagnosis and billing codes. The billing codes most often used at Babies, Kids, and Families are (though not limited to):

90791 – Psychiatric diagnostic evaluation

90837 – Individual therapy

90847 – Family therapy with the client present 50 minutes

90846 – Family therapy without client present 50 minutes

You may call your health insurance provider and inquire if they will reimburse a superbill, and if so, at what rate. This may help with your financial planning. When using a superbill, you pay for therapy at the time of service and submit a superbill to your insurance provider for reimbursement.

You Have the Right to Dispute Your Charges

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

For questions, or more information about your right to a Good Faith Estimate, visit www.cms.gove/nosurprises.