The new law requires most mental health providers to provide patients with detailed upfront cost estimates, including diagnosis. Therapists are concerned that patients may be discouraged from taking a series of treatments.
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The new law requires most mental health providers to provide patients with detailed upfront cost estimates, including diagnosis. Therapists are concerned that patients may be discouraged from taking a series of treatments.
Alex Green / Pexel
A group of representatives of various mental health therapists said new legislation that protects people from surprising medical bills could put healthcare providers in ethical restraints and discourage the care of some patients. I am.
Therapists are fine with the main purpose of the law, which is to prevent patients from being blinded by invoices, usually for treatment received from off-network healthcare providers working at facilities within the network. ..
Instead, they are concerned about another part of the law: the provision of price transparency. The provision requires that most licensed practitioners provide patients with detailed upfront cost estimates, including diagnosis, and information on the length and cost involved in a typical treatment process. Therapists say this is unsuitable for mental health care because the diagnosis is time consuming and can change during the course of treatment.
Finally, the law states that uninsured or out-of-pocket patients can challenge the bill in arbitration if they blow off the quote by at least $ 400.
Claiming that the rule is bothersome and unnecessary, mental health providers wrote to the Ministry of Health and Social Welfare on January 25 to exempt them from “honest” estimates of routine mental health and behavioral health services. I asked. This letter was signed by 11 groups, including the American Psychological Association, the American Association of Social Workers, the American Psychiatric Association, and the Psychotherapy Behavior Network.
Policy experts say it’s not clear how that could happen, but that the law plays a bigger role in determining what insurers can claim even for non-network mental health therapists. Some are worried about allowing it. Exact numbers are not available, but it is estimated that one-third to one-half of psychologists are not networked with insurance companies, the Psychologists Association said. Also, these numbers do not include other practitioners who are not part of the network, such as psychiatrists and licensed clinical social workers.
“We were thrown into this bill, but the intention was [of the law] “It wasn’t mental health, it was expensive medical care,” said Jared Skillings, head of professional practice at the American Psychological Association. [law] Inadvertently allowing private insurers to set regional rates nationwide, which would be a race to the bottom for independent practitioners. “
According to the website Good Therapy, treatment costs vary widely within the United States and by discipline, but generally range from $ 65 to $ 250 or more per hour.
This year, we need to give sincere quotes to uninsured or out-of-pocket patients for medical or mental health care services. They were previously included in the unsurprising law as part of a broader effort to give patients a good idea of cost, both on a visit and during the course of treatment.
Therapists say their professional code of ethics already requires disclosure of the cost of each visit to the patient. When they interpret the rules, it is unethical to request a diagnostic claim code for a quote before meeting the patient, and if you aggregate the cost of treatment for weeks or months, some patients will be treated. They claim that it can interfere with.
Linda Michaels, Chicago’s Private Practice Therapist and Co-Chair of the Psychotherapy Action Network, said:
However, the counter-argument was that one of the purposes of the law was to provide patients with pricing information for mental health services and medical care. This is less opaque and other types of goods and services.
Benedic Ippolito, an economist at the American Enterprise Institute, said he was sympathetic to healthcare providers’ concerns about the additional administrative burden. But “giving consumers a better sense of the financial obligations they are exposed to and imposing some cost pressure on providers are both reasonable goals,” he said.
Even among providers, there is no universal consensus on how burdensome a quote will be.
“Frankly, it’s not unreasonable not only for plastic surgeons and podiatrists, but also for psychiatrists. The episode of care and this is what you get in return,” said the Spirit of the Virginia Institute of Technology Carrion Medicine. Dr. Robert Trestman, Chairman of Medicine and Behavioral Medicine, said. He is a member of the American Psychiatric Association, but has expressed his own opinion.
The Centers for Medicare & Medicaid Services said in a written statement to KHN that mental health providers are not exempt from the rules for honest quotes. However, the agency added that it is working on “technical support for mental health providers and facilities.” Federal agencies often publish additional instructions for rules in the form of FAQs.
The No Surprise Act came into effect on January 1. Its purpose is to prohibit healthcare providers from sending so-called surprise or “balanced” invoices to insureds due to off-network care provided in an emergency or non-emergency situations at in-network facilities. did. .. Although common before the law was passed, such claims often amount to hundreds or thousands of dollars, the amount insurers paid for off-network care, and often much higher claims. It shows the difference from the forehead.
Currently, in most cases, insured patients pay only the amount that would have been charged for in-network care. The additional amount must be calculated between the insurance company and the provider. A group of emergency physicians, anesthesiologists, ambulance providers, and hospitals will be considered by an independent arbitrator when an insurer decides how much to pay a healthcare provider for a disputed claim. Proceedings have been filed over the Byden administration rules outlining the elements to be taken.
However, most mental health services do not touch this part of the directive directly, as they are usually not treated in emergencies or facilities within the network.
Instead, complaints from mental health providers focus on honest quotes.
Additional rules are expected shortly that detail how pre-estimates for people with health insurance will be processed. In a letter to HHS, behavioral health groups fear that insurers will use estimates to limit treatment for insureds and influence payment negotiations with therapists. I am saying.
Some policy experts say they don’t think the law will affect mental health reimbursement in most cases.
“Mental health professionals have exactly the same capabilities as billing off-network and can get patients to agree on the market price of the service,” said the Associate Director of the USC-Brookings Schaeffer Initiative for Health Policy. One Loren Adler said. I have been studying the issue of balance billing for a long time. “There is nothing to limit the Surprise Prohibition Act.”
Some of the treatment group’s concerns can result from misunderstandings of the law or the rules that enforce it, policy experts say, but still reflect the sharing of confusion providers surrounding the development of the law. I am.
In an email to KHN, the CMS said in an email to KHN that the provider could estimate the cost of the initial screening and follow up on additional estimates after the diagnosis on how to handle the pretreatment diagnosis needed to provide a sincere estimate. I did.
“You won’t be forced to diagnose a patient you’ve never met,” Adler said.
KHN (Kaiser Health News) is a national news room that produces detailed journalism on health issues. KHN, along with policy analysis and polling, is one of three major operational programs: KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides the public with information on health issues.
