I encourage you to:

1. Check your insurance card for any information about out-of-network benefits.

2. Call your insurance company or Thrizer, and ask about reimbursement rates for outpatient mental health services using the codes below.

Common Insurance Codes Used in Therapy

• 90791 - Therapy Intake

• 90837 – 60-minute individual psychotherapy

• 90847 – Family or couples therapy with the client present

• 90846 – Family therapy without the client present

The Good Faith Estimate requirements also took effect on January 1,2022. Unlike other provisions of the No Surprises Act, the Good Faith Estimate requirement applies to all health care providers regardless of facility type or in-network status.

In general terms, the requirement is for all uninsured and self-pay clients to be provided with a good faith estimate of the expected cost for the health care items and services offered to them. At this point, there is not yet a requirement for good faith estimates applicable to patients who plan to use in-network insurance benefits.

Existing Washington law regarding disclosure of client financial obligations already requires us to disclose the vast majority of the information that is now required under the Good Faith Estimate provision of the No Surprises Act. However, this new rule is much more impactful for other types of medical providers who do not have a specific legal requirement under Washington law to provide a disclosure of the client’s financial obligations prior to initiating a clinical relationship. The Washington rules can be found here:

https://app.leg.wa.gov/WAC/default.aspx?cite=246-809-710

Under the new federal rule, the Good Faith Estimate of costs for uninsured and self-pay clients must containing the following:

1. Patient name and date of birth;

2. Description of the primary health care item or service being provided in

   clear and understandable language and date of service (if applicable);

3. An Itemized list of health care items or services, reasonably expected to

   be provided;

4. Diagnosis codes, expected service codes, and expected charges

   associated with each listed item or service (if applicable);

5. The provider’s name, NPI, and federal tax ID number (EIN);

6. A list of additional healthcare items or services that the provider

   anticipates will require separate scheduling outside of the expected

   primary period of care (if applicable);

7. A statement that services are expected to be provided weekly (or on

   another basis) until treatment is terminated;

8. Disclaimers that:

   additional items or services that are recommended must be scheduled or requested separately;
   the good faith estimate is only an estimate and that actual charges may differ;

   the client has the right to initiate a dispute resolution process if the actual billed charges substantially exceed the expected charges in the good faith estimate, and the good faith estimate is not a contract and does not require the client to obtain the healthcare services that are being offered.

Deadlines for good faith estimates:
Good faith estimates must be provided to uninsured or self-pay patients within specific time frames. These include:

1. When the healthcare service is scheduled at least three business days in advance, this information needs to be provided no later than one business day after the date of scheduling;

2. When the health care service is scheduled less than three business days in advance, this information needs to be provided only upon client request;

3. When a client requests this information, it needs to be provided no later than later than three business days after the date of the request.

Good faith estimates are considered part of the patient’s medical record and must be maintained in the same manner.

The Federal No Surprises Act has created several new obligations for health care providers, facilities, plans, and insurers that are intended to protect patients and clients from receiving unexpected or “surprise” medical bills.

These surprise billing protections took effect on January 1, 2022. One of the obligations under the No Surprises Act is for health care providers to provide all uninsured and self-pay patients with a Good Faith Estimate of expected charges.

Most of the surprise billing protections apply only to facilities such as hospitals, outpatient hospital departments, critical access hospitals, or ambulatory surgical centers and air ambulance services. In addition, these protections generally apply only to participants, beneficiaries, and enrollees of a group health plan or with coverage offered by a health insurance issuer.

For that reason, the primary obligations under the No Surprises Act are on the insurance companies themselves. Because of this, the insurance companies will inform providers of what (if any) changes need to be made to comply with the federal rules.

I’m partnered with Thrizer to help make out-of-network reimbursement simpler and more accessible. Thrizer can help you understand your benefits, submit claims, and potentially reduce the upfront cost of therapy sessions.