Utah Family Therapy

Good Faith Estimate - "No Surprises" Act

Effective January 1, 2022, laws regulating client care have been updated to include the “No Surprises” act, which requires providers to give current and potential future clients a “Good Faith Estimate” (GFE) on the cost of treatment. Below you will find a summary of this requirement.

Effective January 1, 2022, a provider must furnish a self-pay patient with the notice and GFE prior to all scheduled services. This includes, but is not limited to, office visits, therapy, diagnostic tests, infusions, and surgeries.

What is the No Surprises Act?

The No Surprises Act (NSA) was enacted in December 2021 in accordance with broader COVID-19 legislation and went into effect January 1, 2022. The act aims to reduce the likelihood that patients may receive a “surprise” medical bill by requiring that providers inform patients of an expected charge for a service before the service is provided. 

This act currently applies to healthcare providers (including therapists) who are serving clients who are paying either out of pocket or out of network with their insurance company. It is expected to expand in the coming months to include in-network clinicians as well. Meaning, all therapists will eventually have to comply with the new regulations.

Who qualifies as a self-pay patient?
A provider’s duty to provide notice and a GFE applies to self-pay patients, i.e., an individual who (1) does not have benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, federal healthcare program, or a health benefits plan; or (2) chooses not to use his or her coverage benefit for the item or service.

In many ways, this regulation protects patients from discovering, after they receive care, that they owe a massive medical bill for un-covered services. 

However, therapy is different in that we can’t necessarily provide an estimate of how long it takes to treat a relationship issue, anxiety, depression or and trauma.  

There are to many variables that make it nearly impossible to determine what will be needed for treatment. And there is no way to give a “good faith estimate” on whether or not a client will want to return.

Good Faith Estimate Details

Below reflects current session fees: 

Established clients have already completed their intake appointments and can disregard the fee for that service. 

New clients are required to begin with a 90 minute intake appointment.

Individual Client: Good Faith Estimate
Intake appointment $225
Follow up (50 min) sessions $150
Client sees therapist weekly for 50 weeks in calendar year $7500
Client sees therapist every other week for 50 weeks $3750

Couple/Family clients: Good Faith Estimate
Intake appointment $225
Follow up (90 min) sessions $250
Clients see therapist every week for 50 weeks $12,500
Clients see therapist every other week for 50 weeks $6250

Young Adult IOP clients: Good Faith Estimate
Intake appointment $250
Client sees therapist 4 times every week for 12 weeks $8160
Client sees therapist 4 times every week for 24 weeks $16,320
Client sees therapist 4 times every week for 36 weeks $24,480
Client sees therapist 4 times every week for 48 weeks $32,640
(There is a upfront paid-in-full cash pay option reducing the cost of each IOP session to $167)

Youth IOP clients: Good Faith Estimate
Intake appointment $250
Client sees therapist 4 times every week for 12 weeks $10,000
Client sees therapist 4 times every week for 24 weeks $20,016
Client sees therapist 4 times every week for 36 weeks $30,024
Client sees therapist 4 times every week for 48 weeks $40,032
(There is a upfront paid-in-full cash pay option reducing the cost of each IOP session to $167)

The frequency with which clients are seen, and the duration of time in which they are seen, is dependent on client need. The above examples are for illustrative purposes only and are not specific to you or your treatment. 

Instead they are meant to show the variation of cost over the course of a year.

 


*All individual and Family IOP sessions are billed separately at the Self-Pay rate of $150. 

**Sessions are defined as Groups, Individual and Family Sessions together as a treatment session grouping.

*** There are some additional self-pay options for IOP, like paying for 4 weeks at a time, or at time of service with CC on file, that are not listed here that could lower the overall investment, please inquire for further options.

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