Mental health therapists seek exemption from part of law prohibiting unexpected billing

Conscientious assessments must be made available this year to uninsured or self-paying medical or mental health patients. They were included in the No Surprises Act as part of a broader effort to give patients a good idea of ​​the cost of both a single visit and a course of treatment upfront.

Therapists say their professional codes of ethics already require disclosure to patients of the cost of each visit. They argue that it is unethical to require diagnostic billing codes in the estimate before you see the patient – as they interpret the rule – and counting treatment costs, which can be weeks or even months, may deter some patients from getting treatment.

“If people see a large dollar amount, they may be intimidated or scared and get no help at all,” said Linda Michaels, a Chicago-based private practice therapist and co-chair of the Psychotherapy Action Network.

However, the counterargument is that one of the goals of the law was to provide patients with pricing information—for mental health or medical care—that is less opaque and more similar to what they are used to when purchasing other types of goods or services. Services.

Benedict Ippolito, an economist at the American Enterprise Institute, said he was sympathetic to health care providers’ concerns about the added administrative burden. But “giving consumers a better sense of the financial obligations they’re under and putting some pressure on suppliers are both reasonable goals,” he said.

Even among suppliers, there is no consensus on how onerous the assessments will be.

“Frankly, it’s not unreasonable for psychiatrists, not just plastic surgeons or orthopedists, to say, ‘If you want me to do this and you don’t have insurance or anything, it will cost you X amounts for the entire period. an episode of care, and that’s what you get in return,” said Dr. Robert Trestman, chair of the Department of Psychiatry and Behavioral Medicine at Carilion Tech School of Medicine in Virginia. Although he is on the committee of the American Psychiatric Association, he expressed his own opinion.

The Centers for Medicare and Medicaid stated that mental health providers are not exempt from the rules on good faith assessments in a written statement to KHN. However, it added that the agency was working on “technical assistance targeted at mental health providers and facilities.” Federal agencies often release supplemental rule clarifications, sometimes in the form of frequently asked questions.

The No Surprises Act went into effect on January 1st. Its purpose was to prevent health care providers from sending so-called surprise or “balance sheet” bills to insured patients for out-of-network emergency or non-on-net emergencies. facilities. Typically, prior to the passage of the law, such bills were often in the hundreds or thousands of dollars, the difference between the amount paid by insurers for out-of-network service and the much higher amount often charged.

Now insured patients will, in most cases, only pay the amount they would be billed for online treatment. Any additional amount must be agreed between their insurer and provider. Groups representing EMTs, anesthesiologists, EMS providers, and a hospital have filed lawsuits over a Biden administration rule that lays out factors independent arbitrators must consider when deciding how much an insurer should pay a healthcare provider on disputed bills. .

However, this part of the directive does not apply to most mental health services, as treatment is usually not provided in emergencies or in network settings.

Instead, complaints from mental health providers focus on conscientious assessments.

Additional rules are coming soon that will specify how pre-evaluations for people with health insurance will be processed. In a letter to HHS, the behavioral health groups say they fear ratings will then be used by insurers to limit treatment for insured patients or influence pay negotiations with therapists.

Several policy experts say they believe the law will not affect mental health reimbursement in most cases.

“Mental health professionals will have exactly the same ability to bill out-of-network for patients to settle for any market price for their services,” said Lauren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy, which has been studying balance issues for a long time. “Nothing in the No Surprise Law restricts that.”

Some of the therapeutic groups’ concerns may stem from misinterpretations of the law or its implementation rules, policy experts say, but they still reflect the confusion providers share about the introduction of the law.

Regarding how to handle preliminary diagnoses, which are required to provide conscientious assessments, CMS said in its email to KHN that providers can estimate the costs of initial screening and then conduct additional assessment after diagnosis.

“No one will be forced to diagnose a patient they have not met,” Adler said.

Kaiser Health News is a national health policy news service. It is an editorial independent program of the Henry J. Kaiser Family Foundation and not affiliated with Kaiser Permanente.

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