Good Faith Estimate
“No Surprises” Act
Effective January 1, 2022, laws regulating client care have been updated to include the “No Surprises” act, which requires a wide variety of providers to give current and potential future clients a “Good Faith Estimate” (GFE) on the cost of treatment. Below you will find a summary of this requirement.
Effective January 1, 2022, a provider must furnish a self-pay patient with the notice and GFE prior to all scheduled services or by request if the patient is shopping for care (and not yet at the point of scheduling). This includes, but is not limited to, office visits, therapy, diagnostic tests, infusions, and surgeries.
Who qualifies as a self-pay patient?
A provider’s duty to provide notice and a GFE applies to self-pay patients, i.e., an individual who (1) does not have benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, federal healthcare program, or a health benefits plan; or (2) chooses not to use his or her coverage benefit for the item or service.
It would seem this regulation protects from large bills from unknown costs due to treatment.
However, therapy is a little different in that we can’t necessarily provide an estimate of how long it takes to treat trauma, a relationship issue, address anxiety, make a plan for parenting, focus on and minimize depression, etc. There are a number of variables that make it nearly impossible to quantify what will be needed. And there is no way to give a “good faith estimate” on whether or not a client will want to return for a “tune-up” or may need crisis sessions.
I am not yet clear on how this affects therapists and therapy clients exactly as we cannot predict not is there a one size fits all aka standard cost. In an abundance of caution and in keeping with my policies of general transparency, I am posting this notice.