What is a Good Faith Estimate?
In 2021, a new federal law went into effect. The No Surprises Act requires all self-pay recipients of healthcare services to receive an estimate for those services rendered beyond the coverage of insurance. The purpose of the law is to avoid unexpected fees related to your health.
When it comes to psychotherapy in California, Licensed Marriage and Family Therapists (LMFTs) are required to discuss our fees prior to the onset of therapy. While therapy typically doesn't begin with a predetermined amount of sessions, a Good Faith Estimate can be created with an evaluation that best reflects your care based on previous and current frequency of sessions, or with 6- and 12-month increments used as parameters.
This estimate does not account for any potential reimbursement that you may receive from your insurance company as part of your out-of-network benefits when submitting a superbill.
The estimate must include a diagnosis as a means of contextualizing the services offered. Sometimes clients may not meet the criteria for specific diagnoses but benefit from self-exploration, reflection, and psychoeducation nonetheless. You're encouraged to ask your therapist about any diagnosis outlined on your Good Faith Estimate so that you can better understand your care.
Especially during the early stages of the pandemic, many clients met the criteria for Adjustment Disorder, which is a broad diagnosis indicating the impact of life transitions on mood. These life transitions can include death of a loved one, new relationships, relationship endings, career shifts, pregnancy, medical or psychiatric diagnoses, etc. You may see this on your Good Faith Estimate and understand that it simply outlines depression, anxiety, or an unspecified effect on life transitions that can benefit from therapy.
Share your questions and concerns with your therapist if they arise. They should be willing to explain any information on this document.
But also know that this document is for your reference and since LMFTs in California are already required to discuss fees before services are rendered, this estimate shouldn't present you with any financial information you didn't already have.
Per Centers for Medicare & Medicaid Services:
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.