A bona fide estimate of medical or mental health care services must be provided to uninsured or self-paying patients this year. They were included in the No Surprise Act as part of a broader effort to give patients advance insight into the cost of each visit and a course of treatment.

Therapists say their code of ethics already requires disclosure of the cost of each visit to patients. They argue that it is unethical to ask for a diagnostic billing code in an estimate even before seeing a patient – because they explain the rules – and that calculating the cost of treatment that could take weeks or even months could leave some patients untreated .

“If people see a lot of money, they may be afraid or afraid of not getting help at all,” said Linda Michaels, a Chicago-based private practice therapist and co-chair of the Psychotherapy Action Network.

The counter-argument, however, is that one of the purposes of the law is to provide patients with pricing information for mental health services or healthcare that is less opaque and more similar to what they are used to when buying other types of goods or goods information. Serve.

Benedic Ippolito, an economist at the American Enterprise Institute, said he sympathized with providers’ concerns about the additional administrative burden. But “giving consumers a better understanding of the financial obligations they face and putting some cost pressure on suppliers are all reasonable goals,” he said.

Even among providers, there is no general consensus on the magnitude of the estimated burden.

“Frankly, it’s not a big deal for a psychiatrist, not just a plastic surgeon or a podiatrist, to say ‘if you want me to do this and you’re not covered by insurance or other insurance Reasonable thing, it will cost you X amount, said Dr. Robert Trestman, chair of the Department of Psychiatry and Behavioral Medicine at Virginia Tech’s Carilion School of Medicine. Although he serves on a committee of the American Psychiatric Association, he expresses his opinion.

In a written statement to KHN, the Centers for Medicare and Medicaid Services said mental health providers are not exempt from the rules on bona fide estimates. However, it added that the agency is working on “technical assistance for mental health providers and facilities.” Federal agencies often issue additional rule notes, sometimes in the form of FAQs.

The No Accidents Act took effect on January 1. Its main purpose is to prohibit healthcare providers from sending so-called accident or “balance” bills to insured patients for the provision of out-of-network care facilities in emergency situations or in non-emergency situations provided in-network. Before the law was passed, such bills often ran into the hundreds or thousands of dollars, representing the difference between what an insurance company paid for out-of-network care and the higher amount typically charged.

Now, in most cases, insured patients only pay what they should pay in network care. Any additional amounts must be worked out between their insurance company and provider. Groups representing emergency doctors, anesthesiologists, air ambulance providers and hospitals have filed a lawsuit over a Biden administration rule that outlines what independent arbitrators should do when deciding how much insurers must pay medical providers in disputed bills. factors to consider.

However, this part of the directive does not directly address most mental health services, as treatment is usually not performed in emergency or network facilities.

Instead, complaints from mental health providers focus on bona fide estimates.

Additional rules are expected soon that will clarify how upfront estimates are handled for those with health insurance. In a letter to HHS, behavioral health groups said they were concerned the estimates would be used by insurers to limit treatment for covered patients or influence compensation negotiations with therapists.

Several policy experts said they did not think the law would affect mental health reimbursements in most cases.

“Mental health professionals will have exactly the same ability to bill out-of-network and get patients to agree to any market price for their services,” said Loren Adler, associate director of the Schaeffer Health Policy Initiative at USC Brookings. Long-term study Balance billing issue. “The No Accidents Act doesn’t limit that.”

Some treatment groups’ concerns may stem from a misreading of the law or implementing rules, but they still reflect provider confusion about the law’s rollout, policy experts said.

As for what to do with the pre-treatment diagnosis needed to provide a bona fide estimate, CMS said in its email to KHN that providers can estimate the cost of initial screening and then make additional estimates after diagnosis.

“No one is going to be forced to diagnose a patient they haven’t seen,” Adler said.

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