Good Faith Estimate
No Surprises Act/Good Faith Estimate for Psychological Services
Effective January 2022, the No Surprises Act was passed to protect consumers from “surprise” medical bills from healthcare providers. The purpose is to prohibit an out-of-network provider from charging, without the patient’s prior agreement, their rates for treatment. The Act requires that healthcare facilities and individual healthcare providers furnish a Good Faith Estimate (GFE) of the likely costs of a proposed treatment prior to the self-pay patient’s receiving that service.
We are an in-network (BCBS) and self-pay psychological practice, meaning that we do participate with insurance and accept private pay. We receive payment directly from clients and in-network insurance providers. We do accept payment directly from insurance companies Anthem PPO (e.g. BCBS, Federal Employee Plans), Carefirst, and Medicare. We will submit any documents on behalf of the above insurance clients. We collect copays and or deductibles directly from clients at the time of service.
This law requires that we provide a Good Faith Estimate of what we believe the cost of treatment will entail for private pay clients. In terms of providing an estimate regarding the length of treatment, that is difficult to do as precisely as we would like, as we cannot guarantee how a client will respond to the therapy, how long it will take for the treatment to work, or additional presenting concerns that may arise during the course of therapy that become additional treatment goals, therefore extending the length of treatment. With that said, the average course of treatment in our practice is 6-12 months; occasionally it is shorter, and many times it is longer. For example, we have clients who have been attending therapy for years as they continue to benefit from the treatment and/or value the supportive relationship that therapy provides. Clients attend therapy on their own will, and we attempt to make the costs of sessions and other charges as clear as possible at the onset of the treatment. Below is a summary of the way we charge for sessions, collaborative care (e.g., phone calls with treating psychiatrists), letters, and so on. If you have any questions about a particular charge, you are encouraged to ask the clinician.
Note: The GFE does not currently apply to any individuals who are using insurance benefits, including “out of network benefits” (i.e., submitting superbills to insurance for reimbursement).