Groups representing a range of mental health therapists say a new law that protects people from surprise medical bills places providers under an ethical obligation and could discourage some patients from seeking treatment.
Therapists do not dispute the primary purpose of the legislation, which is to prevent patients from being blindsided by bills, usually for treatment received from out-of-network medical providers who work in in-network facilities.
Instead, they are concerned about another part of the law – a price transparency provision. This provision requires most licensed physicians to provide patients with detailed initial cost estimates, including a diagnosis, and information about the duration and costs involved in a typical treatment. It’s not suitable for mental health care, therapists say, because diagnoses can take time and sometimes change during treatment.
Finally, if they blow the estimate by at least $400, the law says uninsured or self-paying patients can dispute the bills in arbitration.
Arguing that the rule is burdensome and unnecessary, mental health providers wrote a letter on Jan. 25 to the Department of Health and Human Services, asking for an exemption from “good faith” estimates for mental and behavioral health services from routine. 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.
Some also fear the law will allow insurance companies to play a bigger role in dictating what even out-of-network mental health therapists can charge, though policy experts say it’s unclear how this could happen. Although exact figures are not available, it is estimated that between a third and half of psychologists do not network with insurers, the association of psychologists said. And those numbers don’t include other practitioners, such as psychiatrists and licensed clinical social workers, who are also out of the network.
“We were thrown into this bill, but the intention [of the law] was not mental health but expensive medical care,” said Jared Skillings, chief professional practice officer for the American Psychological Association. “We are deeply concerned that this [law] would inadvertently allow private insurance companies to set regional rates across the country, which for independent practitioners would be a race to the bottom.”
Therapy costs vary widely across the United States and by specialty, but typically range from $65 per hour to $250 or more, according to the GoodTherapy website.
Good faith estimates are to be given this year to uninsured or self-paid patients for medical or mental health services. They were included in the no-surprises law as part of a larger effort to give patients a good idea of the cost, both per visit and for treatment, up front.
Therapists say their professional codes of ethics already require disclosure of per-visit costs to patients. Requiring diagnostic billing codes in the estimate before you even see a patient — as they interpret the rule — is unethical, they argue, and counting what could be weeks or even months of treatment costs could prevent some patients from seeking treatment.
“If people see a large amount, they might be intimidated or afraid they won’t get help at all,” said Linda Michaels, a therapist in private practice in Chicago and co-chair of the Psychotherapy Action Network.
The counter-argument, however, is that one of the purposes of the law was to provide patients with price information – for mental health services or medical care – that was less opaque and more similar to what they are used to it when they buy other types of goods or services.
Benedic Ippolito, an economist at the American Enterprise Institute, said he was sensitive to concerns from medical providers about the added administrative burden. But “giving consumers a better idea of the financial obligations they face and putting some cost pressure on suppliers are both reasonable goals,” he said.
Even among vendors, there is no universal agreement on how heavy the estimates are.
“It’s not an unreasonable thing, frankly, for psychiatrists, not just plastic surgeons or podiatrists, to say, ‘If you want me to do this and you’re not covered by insurance or whatever whatever, it will cost you X amount for the entire episode of care and that’s what you get in return,” said Dr. Robert Trestman, director of psychiatry and behavioral medicine at Virginia Tech Carilion School of Medical. Although he sits on a committee of the American Psychiatric Association, he was speaking his own mind.
The Centers for Medicare & Medicaid Services said mental health care providers are not exempt from rules regarding good faith estimates, in a written statement to KHN. He added, however, that the agency was working on “technical assistance for mental health providers and facilities”. Federal agencies often post additional clarifications of the rules, sometimes in the form of FAQs.
The No Surprises law came into effect on January 1. Its purpose was to prohibit medical providers from sending so-called surprise or “equilibrium” bills to insured patients for out-of-network care provided in emergencies or for non-emergency situations in network establishments. . Common before the law was passed, these bills often ran into the hundreds or thousands of dollars, representing the difference between what insurers paid for out-of-network care and the often much higher amounts billed.
Now, insured patients will in most cases only pay what they would have been charged for in-network care. Any additional amount must be agreed between their insurer and the supplier. Groups representing emergency physicians, anesthesiologists, air paramedics and hospitals have filed lawsuits against a Biden administration rule that outlines factors independent arbitrators should consider when deciding how much to pay. an insurer must pay the medical provider for disputed bills.
However, most mental health services are not directly affected by this part of the guideline, as treatment is generally not carried out in emergency situations or in network facilities.
Instead, the complaint from mental health providers focuses on good faith estimates.
Additional rules are expected soon to clarify how initial estimates will be handled for people with health cover. In their letter to HHS, the behavioral health groups say they fear the estimates could then be used by insurers to limit treatment for insured patients or influence salary negotiations with therapists.
Several policy experts say they don’t think the law will affect mental health reimbursement in most cases.
“Mental health professionals will have exactly the same ability to charge out of the network, to have patients accept the market price for their services,” said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy, who has long studied balance billing issues. “Nothing in the No Surprises Act limits that.”
Some of the therapy groups’ concerns may stem from misinterpretation of the law or implementing rules, policy experts say, but they still reflect the confusion providers share around the law’s rollout.
As for how to handle the pre-treatment diagnoses needed to provide good faith estimates, CMS said in its email to KHN that providers could estimate costs for an initial screening and then follow up with an estimate. extra after a diagnosis.
“No one will be forced to make a diagnosis on a patient they haven’t met,” Adler said.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.