The Business of Practice

Navigating the No Surprises Act and Good Faith Estimates

The No Surprises Act, signed into law in 2020, aims to protect patients from unexpected medical bills by requiring healthcare providers to provide upfront cost estimates for services. This legislation introduces new requirements for transparency in billing practices for mental health professionals. In this blog post, we will explore the implications of the No Surprises Act and the importance of providing good faith estimates in mental health care, drawing insights from the American Psychological Association (APA). Additionally, we'll address frequently asked questions (FAQ) to help mental health professionals navigate these changes effectively.

 

Navigating the No Surprises Act and Good Faith Estimates

Understanding the No Surprises Act

The No Surprises Act is designed to shield patients from surprise medical bills, especially from out-of-network providers, by ensuring they can access transparent and upfront cost information. This legislation applies to various healthcare services, including mental health and substance abuse treatment.

Key Provisions of the No Surprises Act

  1. Good Faith Estimates: Healthcare providers, including mental health professionals, must give patients a good faith estimate of expected service charges. This estimate should include details such as the anticipated cost of treatment, the provider's network status, and any other relevant information.
  2. Limiting Surprise Bills: Patients are protected from receiving surprise bills for emergency services, regardless of whether the provider is in-network or out-of-network. Patients receiving non-emergency services from out-of-network providers in in-network facilities are also protected from surprise bills.
  3. Arbitration Process: The No Surprises Act establishes a fair and transparent arbitration process for resolving billing disputes between insurers and healthcare providers.

The Role of Good Faith Estimates

Good faith estimates are crucial in promoting transparency and empowering patients to make informed decisions about their healthcare. Mental health professionals must provide accurate and comprehensive estimates to ensure patients understand the financial implications of treatment. According to the APA, good faith estimates should be provided on time and reflect the anticipated costs based on the services rendered. 
 
Example: Jane, a college student, seeks therapy for anxiety and depression from a licensed counselor. Before beginning treatment, Jane requested an estimate from her counselor to understand the anticipated costs. The counselor provides Jane with a breakdown of the session fees, the number of sessions recommended per month, and any additional costs associated with assessments or materials. With this information, Jane can effectively make financial plans and budget for her therapy sessions.

FAQ: Navigating the No Surprises Act

Q1: What information should be included in a good-faith estimate?

A good faith estimate should include details such as the anticipated treatment cost, including provider fees and facility fees if applicable, the provider's network status, and any other relevant information that may impact the patient's out-of-pocket expenses.


Q2: How soon should a mental health professional provide a good faith estimate?

Mental health professionals should strive to provide good faith estimates to patients as soon as possible, ideally before services are rendered. However, the No Surprises Act requires that estimates be supplied within a reasonable timeframe, typically one business day after the patient's request.


Q3: What should I do if there are discrepancies between the estimated costs and the final bill?

Suppose the costs provided in the good faith estimate differ from the final bill. In that case, patients can dispute the charges and seek resolution through the arbitration process.

The APA has compiled additional FAQs on the No Surprises Act and good faith estimates.

Good Faith Estimate Template

This template can be customized to fit the specific needs and requirements of the mental health professional and their practice. Providing clear and detailed good-faith estimates using a template like this can help promote transparency and foster trust between mental health professionals and their patients.

➡️ Download Template

Conclusion

The No Surprises Act represents a significant step towards protecting patients from unexpected medical bills and promoting transparency in healthcare billing practices. Mental health professionals play a vital role in complying with the requirements of this legislation by providing accurate and timely good-faith estimates to their patients. By adhering to the guidelines outlined by the APA and addressing patient concerns through clear communication, mental health professionals can ensure a smoother transition to these new billing practices and ultimately enhance the patient experience in mental health care.

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