No Surprise Act/Good Faith Estimates

As of January 1, 2022, if you are uninsured or choose to self-pay for healthcare bills (meaning you are not submitting claims to your insurance provider) healthcare providers and facilities are required to provide an estimate of any charges you may expect from a service or item before you receive the service or item. This “good faith estimate” must be provided either upon your request or after you’ve scheduled an appointment. Your good faith estimate will include an itemized list of expected charges for the primary service or item you may receive, plus any service or item that might be provided as part of the same scheduled appointment.

In 2022, this good faith estimate is not required to include services and/or items provided by another healthcare provider or facility (also referred to as a co-provider or co-facility). In 2023, however, cost information from a co-provider or co-facility will be required to be provided by the provider or facility you contact.

What Does This Mean in Mental Health Care?

If you are uninsured or are self-paying for mental health care, you may request a good faith estimate, and if you may expect a good faith estimate after you have scheduled your appointment.

What Healthcare Providers & Facilities Must Provide:

• A good faith estimate prior to a service or item takes place, within certain timeframes that is accessible to you
• An itemized list of the services or items that are grouped by the healthcare provider or facility offering the care and include details specific to the code associated with the care and estimated charge
• If requested, an explanation of the good faith estimate to you either in person or over the phone, as well as a follow-up written estimate (electronic or paper)

What to do with a Good Faith Estimate

With any document pertaining to your healthcare, it is a good idea to keep your good faith estimate in a safe place. You may want to use it to compare it to future bills.

What does a Good Faith Estimate Look Like?

You may view a good faith estimate example here, courtesy of the Centers for Medicare & Medicaid.

What Happens if the Bill is More than the Good Faith Estimate?

In the event that you receive a bill that is $400 or more above the good faith estimate you received for that service or item, you may be eligible to begin the patient-provider dispute resolution process, which is explained in detail here. 

Insurance ID Cards

Updated pricing details will be provided on an electronic or physical insurance plan or insurance identification (ID) card provided starting in 2022. This information will include a phone number and website where more information can be found, applicable deductibles, and out-of-pocket limits.

Your insurance provider may offer more information on their website, which you may find on your ID card, a link on a digital ID card, or a Quick Response (QR) code. 

Prism Therapy Solutions Rates

The cash rate for counseling services at Prism Therapy Solutions is $155 for a session and $185 for an intake session. A fee of $100 will be charged for no-shows or late cancelations.