Groups representing various mental health therapists say the new law, which protects people from surprise medical bills, binds providers morally and may discourage some patients from caring.
Therapists have no problem with the primary purpose of the law, which is to prevent patients from being hit by bills, especially for treatment from outside medical providers who work on network facilities.
Instead, they are concerned about another part of the law: the price transparency provision. For that provision, most licensed physicians are required to provide patients with a detailed cost estimate, including information on the duration and cost of a specific course of diagnosis and treatment. It is not suitable for mental health care, the therapist says, because the diagnosis can take time and can sometimes change during treatment.
Finally, if they raise the estimate by a minimum of $ 400, the law says uninsured or self-paying patients can challenge the bills in arbitration.
Arguing that the rules are strict and unnecessary, mental health providers wrote a letter to the Department of Health and Human Services on January 25 seeking a waiver from "goodwill" estimates for routine behavior 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 fear that the law allows insurers to play a major role in determining what out-of-network mental health therapists may charge, although policy experts say it is unclear how this could happen. Although accurate statistics are not available, approximately one-third to one-half of psychologists are not in the network of insurance companies, according to the Association of Psychologists. And those numbers do not include other professionals, such as psychiatrists and licensed clinical social workers, who are out of the network.
Jared Skilling, chief professional practice officer of the American Psychological Association, said, "We joined the bill, but [the law's] purpose was not mental health but high-cost medical care." "We are concerned that this [law] will inadvertently allow private insurers to set regional rates across the country, which will be a bottom-up race for independent professionals."
According to the Goodtherapy website, the cost of therapy varies across the US and depending on the specifics, but typically ranges from 65 per hour to $ 250 or more.
Patients who are uninsured or pay for health care or mental health services are required to make goodwill estimates this year. They were included in the No Surprise Act as part of a broader effort to give patients a better idea of the cost of each visit and course of treatment.
Therapists say that for their professional code of conduct, patients must be informed in advance of the cost per visit. Estimates require a diagnostic billing code before seeing a patient, they interpret the rule, it is unethical, they argue, and measuring how many weeks or months treatment costs can be can prevent some patients from caring.
Linda Michaels, a therapist at a private practice in Chicago and co-chair of the Psychotherapy Action Network, said, "If people see a lot of dollars, they may be scared or frightened and they won't get help."
The objection, however, is that one of the purposes of the law is to provide patients with pricing information (for mental health or health services) that is less opaque and similar to what is used when purchasing other types of goods. Or service. Service
Benedict Ippolito, an economist at the American Enterprise Institute, said he sympathized with medical suppliers' concerns about the additional administrative burden. But "reasonable objectives are to make consumers better aware of the financial obligations they face and to impose certain cost pressures on providers," he said.
Even among providers, there is no universal agreement on how strict the forecasts will be.
"Actually, not just the plastic surgeon or the podiatrist, but the psychiatrist, 'If you want me to do this and you don't cover insurance or anything, you have to pay X for the whole episode. Dr. Robert Trestman, president of the Psychiatric and Behavioral Medicine at the Virginia Tech Carrelian School of Medicine, said he was a member of the American Psychiatric Association but was expressing his views.
Medicare and Medicaid service centers said in a written statement to KHN that mental health providers are not exempt from rules on goodwill estimates. However, he added that the agency was working on "technical assistance targeted at mental health providers and facilities". Federal agencies often issue additional rule explanations, sometimes frequently asked questions.
The No Surprises Act came into force on January 1. Its purpose was to prevent medical providers from insuring patients from sending surprise or "balance" bills to insured patients for emergencies or non-emergency situations on in-network facilities. . Before the law was passed, such bills often went into the hundreds or thousands of dollars, indicating the difference between the amount paid by insurers for out-of-network care and the amount often charged.
Now, insured patients will in most cases pay the same bill they would have been paid for network care. Any additional charges must be settled between your insurer and the provider. Groups representing emergency physicians, anesthesiologists, air ambulance providers, and hospitals have sued the Biden administration for requiring the insurer to consider independent arbitration when deciding how much to pay the medical provider for the bill.
However, this part of the policy does not directly affect most mental health services because treatments are not usually performed in emergencies or in network facilities.
Instead, mental health care providers focus on good faith estimates.
Additional rules are expected soon to clarify how initial predictions will be handled for people with health coverage. In their letter to the HHS, behavioral health groups say they fear insurers will use predictions to limit treatment to insured patients or to influence salary negotiations with therapists.
Many policy experts say that in most cases they do not think the law affects mental health reimbursement.
"Mental health professionals will have the same ability to bill off-network, so patients will accept any market price for their services," said Lauren Adler, associate director of the USC-Brookings-Schaefer Initiative for Health Policy, who has long studied balance billing issues. "Nothing is prohibited about the No Surprise Act."
Some of the concerns of the therapy groups may be due to inaccuracies in the law or its enforcement regulations, say policy experts, but they also show confusion among providers about law enforcement.
In an email to KHN, CMS said that providers can estimate the cost of the initial assessment and then follow up with additional estimates on how to handle the pre-treatment diagnosis required to predict goodwill. Diagnosis.
"No one will be forced to diagnose a patient they don't know," Adler said.
KHN (Kaiser Health News) is a national newsroom that produces detailed journalism on health issues. Along with policy analysis and voting, KHN is one of the three main operational programs of the KFF (Kaiser Family Foundation). KFF is a for-profit organization providing information on health issues to the country.