The payers are keenly awaiting the outcome of an apprehension shown by the groups representing a range of mental health therapists, about a new law that protects people from surprise medical bills. Therapists say it puts providers in an ethical bind and could discourage some patients from care. This development will have a bearing on how the insurers react to the proposals as made in the No Surprises Act. The therapists are concerned about one specific proposal—a price transparency provision — that requires most licensed medical practitioners to give patients detailed upfront cost estimates.
- ‘Legislation’s motive not an issue’: The therapists say that there can be no aspersion cast on the aim of the legislation which is to prevent patients from being overburdened by bills, usually for treatment received from out-of-network medical providers who work at in-network facilities. However, they are worried over the part of the law that requires most licensed medical practitioners to give patients detailed upfront cost estimates, including a diagnosis, and information about the length and costs involved in a typical course of treatment. Therapists fear that such a law is not viable for mental health care as diagnoses can take time and sometimes change over the course of treatment. This will also likely result in insurers being forced to wait and watch before making disbursements.
- $400 estimate cap uncalled for: The bill has also capped the estimate at $400 and if the providers give higher final estimates, as per the law, uninsured or self-pay patients can challenge the bills in arbitration. Vehemently opposing this provision, mental health providers have said that the rule is burdensome and unnecessary. In a letter to the Department of Health and Human Services, they sought an exemption from the ‘good faith’ estimates for routine mental and behavioral health services. The letter was signed by 11 groups, including the American Psychological Association, the National Association of Social Workers, the American Psychiatric Association, and the Psychotherapy Action Network.
- Therapy costs vary between $65 and $250/hour: According to a website GoodTherapy, the costs of treatment fluctuate widely across the country and by specialty, and generally range from $65 an hour to $250 or more. The good faith estimates must be given this year to uninsured or self-pay patients for medical or mental health care services. No Surprises Act incorporated this rule in an effort to give patients a good idea of cost, both per visit and for a course of treatment, in advance.
- Code of ethics requires costs disclosure: Contesting the need for such a provision, therapists say their professional codes of ethics already require disclosure to patients of per-visit costs. They say that providing diagnostic billing codes in the estimate before even seeing a patient is unethical as adding up what might be weeks or even months of treatment costs could keep some patients from undergoing care.
- Experts allay therapists’ fear: Several policy experts say they do not think the law will affect mental health reimbursement in most cases. “Mental health professionals will have the exact same ability to bill out-of-network, to have patients agree to whatever market price is for their services,” said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy, who has long studied balance billing issues. Some of the therapy groups’ concerns may stem from misreading the law or rules implementing it, say policy experts, but they still reflect the confusion providers share surrounding the roll-out of the law.