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2021 No Surprises Act - here’s what therapists need to know!


The new year brings many changes and among them is the implementation of a new federal law that affects all healthcare providers, including therapists — the 2021 No Surprises Act.


What is the 2021 No Surprises Act?

The 2021 No Surprises Act is a law enacted to protect people from getting unexpected bills from healthcare providers. It went into effect on January 1, 2022 (Note, portions of this law relating to in-network providers will not go live until 2023, to allow providers and healthcare organizations time to update policies and procedures). This act currently mandates the following:

  • Requires out-of-network healthcare providers to talk to people about health insurance

  • Requires out-of-network healthcare providers to estimate the cost of healthcare services in the form of a “Good Faith Estimate” — this is mandatory for all new clients and an option for all current clients (if they request)

  • Allows clients to dispute their bill if treatment costs exceed the Good Faith Estimate


What do I need to do as a therapist?

  1. For new clients, the law explicitly requires you to ask clients if they have health insurance (for a sample script, see “Other Important Information” below) Note: the law does not require you to accept insurance.

  2. If clients are insured, the law also requires you to ask if they intend to submit a claim for reimbursement

  3. If clients say “no” to either question, you must provide a Good Faith Estimate, within a specific timeframe (see Timing below)

  4. If clients say “yes” to both, meaning they are insured and will use their in-network coverage, you do not need to provide a Good Faith Estimate

  5. You must ask at the time the client schedules the appointment

  6. If you don’t accept insurance, it's a good practice to remind clients of their option to submit claims for out-of-network reimbursement.

  7. For new, uninsured or self-pay clients, the law explicitly requires you to give clients an estimate of their total cost, verbally and in writing

  8. We recommend you talk about this in the first session (for a sample script, see “Other Important Information” below)

  9. If any current clients request a Good Faith Estimate regarding future sessions, you must also provide one to them

  10. You must disclose to prospective clients that they are entitled to this Good Faith Estimate. You can disclose this either on your website, or physically posted in your office. If you have neither an office nor a website, the mandate remains, but the law does not specify how to achieve compliance; we suggest that you include a brief notification as a part of the voicemail message on your intake line.

  11. You can use our disclosure and estimate forms as templates (the APA also provides a template here)

  12. No Surprises Act disclosure

  13. Good Faith Estimate


What does reflect do to help our therapist comply?

  • One of our core principles is price transparency, so we already set standard rates with all our providers and publish pricing on our website

  • We preemptively ask reflect clients about their insurance status as part of their onboarding process and assist them with submitting claims for out-of-network reimbursement

  • Our website includes the mandatory disclosure that reflect clients are entitled to a Good Faith Estimate (see here)

  • For all new reflect clients, we provide the mandatory Good Faith Estimate on our therapists’ behalf before the first session (Note, since individual client situations may vary substantially, our Good Faith Estimate is given as a range)

  • If any current reflect clients request a Good Faith Estimate, we provide one on our therapists’ behalf

If you partner with reflect, you’re in luck! - our team will handle compliance for all reflect clients. If you’ve been considering working with us, click here to apply now! Benefits include not only free legal updates like these, but also fit-based matching, simplified scheduling, billing with a >99% collections rate, connection to a diverse community of professionals, and more!


Additional important information

The Good Faith Estimate

The estimate must be provided verbally and in writing.

  • To see the estimate that reflect provides to clients, click here

  • We suggest giving this estimate at the beginning of the first session

  • Example of verbal estimate: “It can be helpful to know up front how much therapy will cost. In fact, there is a new federal law that requires me to give you an estimate in this first session. For our work together to help you, I expect we’ll need to meet for up to 30 sessions. At my current rate of $50, that would total about $1500 (30 sessions x $50 = $1500). I’m still getting to know you, so it’s hard to say exactly, but that’s why it’s an estimate. The amount could change if we meet more or less often. Regardless, I hope that you see therapy as a valuable investment in your well-being”

  • Example of insurance question: “Do you have health insurance? If so, are you planning to submit a claim to your insurance? I’m asking because if you are using in-network benefits, eventually [in 2023] the law will require me to send the estimate to your insurance company.”

Timing

  • Good Faith Estimates must be provided for new clients depending on how far in advance their first appointment is scheduled

  • If their first appointment is scheduled at least 3 business days in advance: within 1 business day of scheduling

  • If their first appointment is scheduled at least 10 business days in advance: within 3 business days of scheduling

  • If their first appointment is scheduled less than 3 days in advance: the law does not specify whether an estimate is required

  • Good Faith Estimates must be provided for current clients within 3 business days of their request

Disputes

  • Clients can dispute their bill if it exceeds the Good Faith Estimate by $400

  • Clients must initiate disputes within 120 days of receiving their bill

  • Clients pay a $25 federal fee to initiate a dispute

  • Disputes are settled via independent arbitration (i.e., not a lawsuit)

  • Clients must contact the US Department of Health and Human Services to initiate the process and choose an authorized arbitration service

As with any new law, regulations are subject to different and evolving interpretations and we encourage you to do your own research and seek legal guidance as appropriate. We will update this post as we know more. You can also check out the CAMFT or APA websites. To read more about the law itself, please visit the website for the Center for Medicare and Medicaid Services (CMS).


Please comment below! If you have questions or for more information, feel free to contact us at therapists@joinreflect.com.