Good Faith Estimate
What is it?
Beginning January 1, 2022, federal laws regulating client care have been updated to include the “No Surprises” Act. Under the law, healthcare providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services called a “Good Faith Estimate” (GFE) explaining how much your medical care will cost.
The act is described as “new federal protections against surprise medical bills. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose.” This new regulation is designed to provide transparency to patients regarding their expected medical expenses and to protect them from surprises when they receive their medical bills. It allows patients to understand how much their health care will cost before they receive services.
How does this affect me in therapy here?
It is highly unlikely this would affect our work together. There will be no situation in which you would “inadvertently” receive care from me or with no choice. Also, the final rules about how to implement this in a practice such as mine have not been written yet by the federal government. I am “out of network” for all insurance companies. My practice is private pay only; I do not charge, bill or engage with insurance companies. I avoid diagnoses when possible. I only accept cash, check or credit card payments at the time of service. My fee is stated up front and is predictable. I do not carry balances. The fee for one session must be paid before the next session starts.
There are a number of factors that make It challenging to provide an estimate on how long it will take for a client to complete therapeutic treatment, and much depends on the individual client and their goals in seeking therapy. Some clients are satisfied with a reduction in symptoms while others continue longer because it feels beneficial to do so. Others begin to schedule less frequently, and may continue to come in for “tune ups” or when issues arise. Ultimately, as the client, it is your decision when to stop therapy.
How long you need to engage in therapy and how often you attend sessions will be influenced by many factors including
❖ Your schedule and life circumstances
❖ Therapist availability
❖ Ongoing life challenges
❖ The nature of your specific challenges and how you address them
❖ Personal finances
You and I will continually assess the appropriate frequency of therapy and will work together to determine when you have met your goals and are ready for discharge or less frequent visits.
According to the American Psychological Association, “on average 15 to 20 sessions are required for 50 percent of patients to recover as indicated by self-reported symptom measures”. Additionally, they state that through the working relationship between the client and counselor sometimes the preference is for “longer periods (e.g., 20 to 30 sessions over six months), to achieve more complete symptom remission and to feel confident in the skills needed to maintain treatment gains”. (https://www.apa.org/ptsd-guideline/patients-and-families/length-treatment)
The counselor is the expert in the field, and the client is the expert in their own life. The counseling journey is a shared process between therapist and client at every turn of therapy, and it is neither practical nor possible for organic, healthy growth to occur if the therapist and client are continually tasked with re-writing an expense projection every step of the way.
Clients are always encouraged to voice their thoughts and preferences, including choice of therapist, session length, types of interventions used, and focus of each session. Therapists are tasked with providing clinical and financial feedback to clients about various ways to reach these goals and reasonable expectations concerning the parameters clients desire.
For a good faith estimate: the amount you would owe if you were to attend therapy for 52 sessions in a year (weekly, without skipping any weeks for holidays, break, vacation, unplanned events/sickness, etc.).
A GFE for my services is simple = Fee per session X Number of Sessions.
Example: $125 x 52 (50 min, sessions in a year) = $6,500
$190 x 52 (80 min, sessions in a year) = $9,880
The above examples are provided to give an idea of the financial expectations for a calendar year. The frequency and duration is dependent on your individual needs, goals, and desires. The number of sessions is determined collaboratively and cannot ethically or realistically be estimated, and certainly not before we’ve gotten to know each other.
Disclaimer:
- This Good Faith Estimate shows the cost of items and services that are
reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.
- The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment
I prefer an overly cautious and conservative approach when asked to project a client’s potential expense. Rest assured that I will be as transparent with you about the costs of the services we agree on together. You will have no surprises here. In the meantime, you may certainly ask me about any costs about which you may be unsure, and I will provide you with clear information.
Information required for the GFE
Services Offered: Psychotherapy Sessions (Individual, Couple, Family)
Common Diagnostic Codes Used at Arrow Counseling Services: (however, the list is not exhaustive. With that said, diagnosis codes can change based on many factors. Please speak to your therapist with any questions or concerns.)
❖ Adjustment Disorder (F43.23)
❖ Mental Disorder, Not Otherwise Specified (F99) ❖ Depression (F32.9)
❖ Anxiety (F41.1)
❖ Bipolar (F31.9)
❖ PTSD/Post Traumatic Stress Disorder (F43.10)
Service Codes for Services Provided:
❖ 90834: 45-50 minute psychotherapy session ($125)
❖ 90847/46: Family/Couples psychotherapy session ($125)
❖ 90837: 53+ minute extended psychotherapy session ($190)
Provider Information:
Name: Micah Loyd, LPC/MHSP
NPI: 1619435799
Tax ID: L0596763520
Location Where Services Provided: Services are provided in the office (575 S Royal St. Jackson, TN) or via telehealth.
**All of this information is also included in the paperwork and discussed in the intake session**