What Do I Need to Know About the No Surprises Act Good Faith Estimate for Therapists?

Maybe you’ve heard a little about the No Surprises Act that went into effect in 2022. 

Do you know what this means for your practice? 

It’s easy to scroll through the emails and journals and not really digest the headlines coming your way. How do you even know which ones actually require your energy? 

Clarity Cooperative supports therapists with the most important information you need to know. That’s why we’re going over the No Surprises Act and Good Faith Estimate in detail here. If you want more, we’ve got a post on Easy Ways for Therapists to Create a GFE, and a convenient GFE Calculator tool.

Since this legislation is new, it’s understandable if you’ve got questions about it. 

How does it affect you, and how do you write an estimate? 

Let’s dive deeper into what all this change is about.

The No Surprises Act Good Faith Estimate for Therapists

Some surprises can be pretty nice – gifts, unexpected visits from loved ones, or a party in your honor. There are also ones that are quite the opposite, like unplanned expenses. 

Have you ever gone to the doctor and been shocked by the fee due afterwards? Or, maybe you've avoided seeking medical care altogether because of the costs. You’re not alone. 

An overwhelming majority of healthcare consumers are shocked by medical bills. This is particularly true of those that pay out-of-pocket. A few states already had some measures in place to help with this, but it wasn’t enough. Federal action was deemed necessary and the No Surprises Act was born.

As part of this new law, the Good Faith Estimate (GFE) is a requirement for all healthcare providers. This includes therapists. Treatments for mental health and substance abuse disorders fall under this act. 

Therapy Good Faith Estimate

Good Faith Estimates are a quote that lists the services and associated fees a client can expect. Therapy is typically ongoing, for a year or even more. Most providers will prepare one to cover a full year of appointments. A new one is provided annually.

Here are the basics of a GFE:

• Client and therapists information
• Expected diagnosis and treatment codes
• Frequency of sessions
• Total costs

If you want to easily create an accurate estimate, check out our GFE calculator tool. Our tool already includes diagnosis and treatment codes. It even automatically totals the costs up for you. 

Situations Requiring a Therapy GFE

Let’s start off with some good news. Depending on the clients you see, not all will need a GFE. The ones that require it are those that are self-paying, uninsured, or choose not to use their insurance. Clients that pay out-of-pocket tend to have the largest expense with healthcare services. They are the main focus of this legislation.

If you mostly see clients that are self-pay, we know it can seem like a lot of work added to your plate. That’s why we’ve created these resources and our GFE calculator tool to help you. We’ve got some tips to help you incorporate this process into your practice seamlessly. 

Asking Clients About Health Insurance

A great first step is to ask about your client’s health insurance. If they have coverage from a company that you work in-network with, you don't need a GFE. The same applies for those enrolled in Federal healthcare programs like Medicare or Medicaid. 

Asking if they know of any changes coming to their coverage can help you be prepared. 

Their plan might be in-network, but they could change jobs and become out-of-network. Your client could also lose insurance completely. If the client continues working with you, you’ll have to provide a GFE.

Preparing Therapy GFEs for New vs. Existing Clients

Treatment plans and diagnosis codes can be hard to predict in certain cases. This is true if you have a new client you’ve never met before. Since the guideline is to have the GFE delivered prior to their first booked session, you can give them an updated GFE later. The first one can include the initial consultation, a few follow up sessions. You can write what you expect their diagnosis to be. After getting to know the individual and their needs better, an updated GFE can be given then. 

Existing clients are a bit easier to prepare GFEs for, as most of the time they will just need a new one every 12 months. If your fees have changed, those should be reflected as well as any new diagnosis and treatment codes. Keep in mind though, if any changes to the treatment plan occur the estimate may need to be updated. 

Fluctuating Treatment Plans & Emergencies

It’s common for a client to increase or reduce the frequency of therapy sessions at any given time. Life events happen that could affect this. So you might be wondering, “How can I predict what expenses will come up during an entire year?”

Let’s use the example of a home renovation. The contractor can only provide you a quote based on the available information. If some hidden issues inside your walls come up after the work has begun, they give you a new quote.

Similarly, for a therapy client, a GFE can is based on the information you have at your disposal. Unpredictable events are not in the estimate. This includes emergencies and unexpected appointments. If a treatment plan does get adjusted you'll need a new GFE. 

Letting Clients Know a GFE is Available

It doesn’t have to be shouted from the rooftop, but it should be made known that GFEs are available.  

You can practice letting prospective clients know that a GFE is available. Ideally, before setting up appointments. A great time to mention the GFE and gather extra information is during the consultation call.

Other ways to notify clients that an estimate is available is by posting notices. These can be in your office and on your website. These should be clear, easy to understand, accessible, and available in different languages. Even better if it’s found through an online search of your website.

Building Client Trust

As the receiver of these financial transactions, it might not seem like a big deal to you. However, we know finances can be a huge trigger for stress or other issues for many people. If you were a client receiving a GFE, it would feel nice and seem like the therapist was being thoughtful.

Being transparent with your fees and treatment plan can help build trust with your clients. They'll also be able to plan for expected costs. They'll feel empowered over their finance and healthcare choices. 

Save Time Creating Therapy GFEs In Your Practice

If you have a lot of uninsured or self-pay clients, it might seem like a lot of paperwork to manage and keep track of. 

A best-practice for you may be to provide new clients with a GFE right away. For existing clients you could set aside time to send them out at intervals throughout the year. This way you can save time and stay organized. You can set up these intervals in a way that works with your flow. It could be weekly, monthly, or quarterly.   

Clarity Cooperative also provides therapists access to our Practice Toolbox and GFE Calculator. All accessible with this two week risk-free trial to our Pro subscription. This calculator has been pre-filled with diagnosis and treatment codes. You can even enter your own fees and frequency of sessions to get a total cost for the year. We can help you save time and avoid the potential headache of trying to calculate GFE's for your clients. 

Timing of Delivery

The No Surprises Act provides us with a timeline for GFE delivery to a client. It can seem like a lot of details so, as you read the guidelines below, try to keep a “three day rule” in mind. 

For a new client, if the session is booked:

• 3+ business days in advance, the GFE must be delivered in 1 business day
• 10+ business days in advance, the GFE has to be delivered within 3 business days
• Less than 3 business days in advance, a GFE is not required before the appointment

If an estimate is requested by anyone, a GFE must be provided within 3 business days. Sometimes a prospective client requests a GFE, but doesn't book an appointment until a much later time. This situation warrants a new GFE. Any revisions should be sent at least 1 business day before the scheduled session. 

Approved Therapy GFE Delivery Methods

Therapists aren’t required to send the GFE via any specific delivery method. Here are the most likely options and suggestions on each.

The U.S. Postal Service is a federally operated and approved method of delivery. If your client prefers to receive correspondence via mail, this is perfectly acceptable. Letters are postmarked. As long as it's dated within the timeframe listed (see above), it should be enough. 

Though email isn’t a secure method of contact, unless encrypted, clients can consent to communication this way. If you prefer to keep a paperless practice, Electronic Health Record (EHR) systems are a secure option. Some have portals that clients can access to retrieve records and messages. 

A GFE can be delivered verbally. The estimate should still be in writing though, and delivered to the client via mail or electronically. 

If you have an ongoing client that needs a new GFE for the year, you can give it to them during their appointment. The delivery methods mentioned above apply here as well. 

Record Keeping and GFEs

If a client requests an old copy of an old GFE, would you know where to look? 

Maintaining organized files and charts may not be the strongest skill for some of us. So, it's important to point out that these estimates are an essential part of a client’s medical record. They have the same importance as progress notes. 

Medical records are required to be kept securely for 6 years or for the length of time your local jurisdiction requires, whichever is longer. Therapists can keep track of each time an estimate was sent by recording the date and method of delivery. This will help in case you or a client needs to reference an old GFE again. 

Client Signatures 

The law doesn’t include any exemptions for a GFE. It might seem like a smart move for your convenience to create a waiver for GFEs. Some of your clients may also want to do the same, or refuse to sign the estimate itself. Luckily, the document doesn’t require their signature. So as long as it's delivered, you’ve completed your part. 

If the client refuses to sign a GFE, you can refer them to another therapist. If you're comfortable working with them, then note this in their chart. Another option would be to let them know that they won't receive a GFE if they can find a provider that is in-network with their insurance plan. 

Flexibility in the Estimate

Remember that a Good Faith Estimate is exactly that – an estimate. As a therapist, you have some room for error within the total cost provided. The amount your client spends on sessions with you could end up being more or less than estimated.

The only situation where you might feel some concern is when the total cost is over $400 more than on the GFE. The client does have the legal right to file a complaint with the Federal government. This would enter into a third party dispute resolution process. 

If a client happens to file a complaint, you’ll be notified of this. You'll also have 10 business days to provide the following:

• Copy of the client’s GFE
• Copy of the client’s bills
• Documentation to support that events contributed to additional fees and could not have been reasonably anticipated 

Finding and Editing Errors 

We’re all human – typos, misspelled words, and small mix-ups happen when we’re doing many things. To help reduce error, use our GFE Calculator tool, and try to work on one patient chart at time.  

If you notice a mistake on a GFE that's already been sent, try to send a revised estimate as soon as possible. If you make edits, it's good practice to have it delivered at least one business day before their next session. This way, they’ve been notified with enough time. They'll know about the different treatment plan or different payment than already expected. 

Updating GFEs throughout the year and correcting errors as soon as you notice might seem tedious. Setting aside a few minutes to make sure you’re in compliance can avoid potential disputes later on. In the case you end up in a dispute process and need to provide documentation. You’ll already have everything in their record to easily pull up. 

Supporting You with the No Surprises Act Good Faith Estimate for Therapists

At Clarity Cooperative we are here with the resources to help you navigate the requirements of the No Surprises Act and Good Faith Estimate. 

Sign up for a risk-free two week trial to give our GFE Calculator tool a try, we know you’ll love it. We also welcome you to come say hello to our community, where we support each other in doing what we love: helping our clients.