Your Right to a Good Faith Estimate for Therapy Services

Notice Under the Federal No Surprises Act

You have the right to receive a Good Faith Estimate explaining how much your therapy with me will cost.

Under the federal No Surprises Act, people who are uninsured, or who are insured but are not using their insurance to pay for therapy services, have the right to receive a written estimate of the expected cost of their care before they receive it. I do not bill insurance companies directly, so this right applies to nearly everyone I work with in therapy.

What You Have the Right to Receive

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency therapy services I provide. This includes psychotherapy sessions and the related services that go with them, including but not limited to reviewing records, reading and responding to correspondence, consulting with other professionals involved in your care, and preparing letters or documents at your request.

How You Get One

·       You do not have to ask. When you schedule therapy with me, I will give you a Good Faith Estimate without your having to ask for it, and you will have it before we begin.

·       You can also ask, any time. Ask before you schedule anything, or well into our work together, and I will get it to you promptly. Any conversation with me about what services are likely to cost counts as a request.

·       Short notice: If we schedule something on short notice, I will still get you an estimate as quickly as I can.

·       Ongoing therapy: Because therapy is ongoing rather than a single appointment, an estimate for recurring services covers a stated period of up to 12 months. I usually start with 6 months. If your care continues beyond that period, or if my rates change, I will give you a new estimate, and you can always ask for one.

·       If things change: If the expected scope of your care changes (different services, a different frequency, or a different cost), I will give you a new estimate before the next scheduled service.

You will always receive the estimate in writing, on paper or electronically, in a form you can save and print. If you would rather I walk you through it out loud first, I am glad to, and I will still give you the written version.

What an Estimate Is, and Is Not

·       It is an estimate of the services I reasonably expect to provide, based on what I know when I prepare it.

·       It is not a contract, and it does not obligate you to receive services from me.

·       It is not a guarantee. Your actual charges depend on the services you actually receive, which in therapy depends a great deal on decisions we make together as we go.

·       There may be services I recommend as part of your care that have to be scheduled or requested separately. Those are not included in the estimate, and you can ask me for a separate estimate for any of them.

If Your Bill Is Much Higher Than Your Estimate

If you receive a bill from me that is at least $400 more than the total of your Good Faith Estimate, you have the right to dispute the bill through the federal patient-provider dispute resolution process. An independent third party reviews the bill and decides what you owe.

·       You must start the process within 120 calendar days of the date on your bill.

·       There is a $25 administrative fee, which you pay to the independent reviewer to start the process. If the dispute is decided in your favor, an amount equal to the fee is credited against what you owe me.

·       While a dispute is pending, federal rules do not allow me to send the disputed bill to collections or threaten to, and late fees on the disputed amount are suspended.

·       Disputing a bill will not affect the quality of the care I provide to you, and it will not affect our working relationship.

Please bring any concerns to me first. Many billing issues may simply be a misunderstanding or a mistake on my end, and I would like the chance to fix them.

Keeping Your Estimate

Keep a copy of your Good Faith Estimate. Your estimate is part of your clinical record and I keep it the same way I keep the rest of your record. You can ask me for a copy of any Good Faith Estimate I have issued to you within the past 6 years.

Couples, Families, and Others Who Share Your Care

If more than one person takes part in your therapy with me and you will be sharing the cost, you are welcome to ask me for your own Good Faith Estimate, and I can provide one to each of you. If you are not sure how this applies to you, ask me before we begin, and I will explain it.

Court-Ordered Family Therapy and My Other Services

Court-ordered family therapy is not reimbursable by health insurance, because it treats a family or a relationship rather than a single patient with a diagnosis. I prepare Good Faith Estimates for that service on a service-specific form that reflects how the work and the costs are actually structured.

I offer other services that are not therapy, including parenting coordination, mediation, and legal services, so this notice does not apply to them. You are welcome to ask me for a rough idea of what those services might cost.

For More Information

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059. For insurance-related billing questions, the Oregon Division of Financial Regulation can be reached at 888-877-4894.

This notice is posted in my office, at the place where scheduling and questions about cost occur, and on my website at laurenmacneill.com.