No Surprise Act of 2021
Under a new federal law to protect clients and patients from surprise health care bills, Licensed Clinical Social Workers (LCSW) and other health care provider types must, effective January 1, 2022, provide a Good Faith Estimate (GFE) of expected charges that may be billed for items and services to individuals who are uninsured (e.g., not enrolled in any health plan or coverage) or who are self-pay (e.g., not seeking to file a claim with their plan or coverage). The GFE must be provided both orally and in writing, upon request or at the time of scheduling health care items and services, and within specific timeframes. A Good Faith Estimate is an estimation of the expected charges provided in advance of scheduled services.
The rule applies to both current and future clients who are uninsured or self-pay. Providing a GFE to clients is not new to LCSWs who, as part of best clinical practice, routinely discuss services and fees before or during the initial interview with new clients.
In the event that a client has an insurance plan that offers out of network benefits, a Superbill (insurance reimbursement statement) may be requested so claims for reimbursement can be submitted by the client to their insurer. It is the client’s responsibility to know and understand their insurance plan and benefits. Anxiety and OCD Pathways, LLC does not verify any insurance plans or benefits, nor submit claims on behalf of clients. Therefore, Anxiety and OCD Pathways, LLC does not guarantee that clients will receive any reimbursement in any amount from their insurance carriers.
Appendix A:
CPT billing Code 90832: 30 minute therapy session $75
CPT billing Code 90834: 50 minute therapy session $150
CPT billing Code 90837: 90 minute therapy session $200
CPT billing Code 90847: 50 minute family therapy session with client present $150
CPT billing Code 90846: 50 minute family therapy session without client present $150
[Limited slots for further reduced rate offered on a significant needs basis]
Length and frequency of treatment:
• Therapist availability
• Ongoing life challenges
• Client’s active engagement in change processes in-between sessions.
Appendix B: Good Faith Estimate Disclaimers
For questions or more information about your rights to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059