Therapists say their professional codes of ethics already require disclosure of per-visit costs to patients. Requiring diagnostic billing codes in the estimate before they even see a patient, they interpret the rule, is unethical, they argue, and counting treatment costs that could amount to weeks or even months could prevent some patients from getting treatment receive.
Groups representing a variety of mental health therapists say a new law protecting people from surprise medical bills ethically binds providers and could discourage some patients from seeking treatment.
Therapists have no problem with the legislation's primary objective, which is to prevent patients from being shocked by bills, typically for treatments they receive from outside medical providers working in facilities within the network. Instead, they're concerned about another part of the law, a price transparency provision that requires most licensed physicians to provide patients with detailed cost estimates in advance, including a diagnosis and information about the length and cost of a typical treatment. This is not suitable for psychiatric care, because diagnoses can take time and sometimes change in the course of treatment.
Finally, if they add at least $400 to the estimate, the law says uninsured or self-paying patients can contest the bills in arbitration.
Arguing that the rule is onerous and unnecessary, mental health providers wrote a Jan. 25 letter to the Department of Health and Human Services requesting an exception to “good faith” estimates for routine behavioral and mental health services . 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 psychiatric therapists outside the network can charge, although policy experts say it's unclear how that could happen. Although exact figures are not available, an estimated one-third to one-half of psychologists are not connected to insurers, according to the psychologists' association. And these numbers don't include other professionals, like psychiatrists and licensed clinical social workers, who are also outside the network.
"We participated in this legislation, but the intent [of the law] was not mental health, it was costly medical care," said Jared Skillings, chief professional practice officer of the American Psychological Association. "We are deeply concerned that this [law] inadvertently allows private insurance companies to set regional rates across the country in what would be a race to the bottom for independent professionals."
Therapy costs vary widely across the US and by specialty, but typically range from $65 an hour to $250 or more, according to the GoodTherapy website.
Good faith estimates must be presented this year for uninsured or self-paying patients for health care or mental health services. They have been included in the No Surprises Act as part of a broader effort to give patients a good idea upfront of the costs, both per visit and per treatment cycle.
Therapists say their professional codes of ethics already require disclosure of per-visit costs to patients. Requiring diagnostic billing codes in the estimate before they even see a patient, they interpret the rule, is unethical, they argue, and counting treatment costs that could amount to weeks or even months could prevent some patients from getting treatment receive.
