The no Suprises Act and the Michgian LPC

Starting January 1, 2022 The No Surprises Act will begin to attempt improve billing transparency between services provided (by LPCs and lots of other medical/mental health professionals) and clients. The Act requires that service providers inform clients, up front, of expected charges for services before any service is provided via a good faith estimate of all costs for services.

If you’re short on time, and just need to cover your basis to be in compliance with this new Act, I’d recommend adding the following to your professional disclosure statement that you’re providing clients (AND getting a signature that they received/were offered a copy AND keeping a copy of this signed document for at least 7 years for each client…you’re doing that right?):

• As a client of (insert LPC name/agency) I understand that my insurance may not cover all of the health care services (insert LPC name/agency)is scheduled to provide

• I was offered a good faith estimate of the total cost of services (I’d also add a line that the client could initial that a copy was provided to them, or that they declined one).

• I understand that at any time I can decline services with (insert LPC name/agency) and request, through my insurance company, a list of in network providers.

Now for more details -

Due to copays, deductibles and (other) hidden costs associated with medical/mental health billing, clients are sometimes caught off guard by out of pocket costs that can really begin to add up before anyone outside of the insurance company is even aware that there is an issue. We all know that insurance claims can sometimes take a few months to be returned paid or rejected.

This Act shouldn’t change much within your private practice - however - I’ve found that many Michigan LPCs struggle a bit to discuss the money part of our services with clients. As always, it’s much easier to begin therapy with new clients setting boundaries and expectation up front.

Most of what is in the No Surprised Act aims to protect clients, whom have insurance, against unexpected bills during emergency services where they’re not able to choose who (doctor/agency/therapist etc.) is providing the services. The Act also protects against costs piling up, unknowingly, for services rendered from an out of network provider/facility - these services tend to cost more than in network services. Prior to this Act, out of network providers or emergency services providers could bill the remaining balance of services (that a client’s insurance company denied) directly to the client, leaving the client to receive a bill months after completely out of the blue. This act also seeks to ensure that uninsured clients receive a good faith estimate that gives an approximate total cost of care, upfront, before any services are rendered.

The discussion about your fees for services needs to begin during your initial contact with a new client. This practice begins to lay the groundwork for a more in-depth conversation about insurance, billing and your fees for service. It’s best to begin discussing fees for your intake and future therapy sessions during your initial conversations with new clients while you’re gathering some demographic and insurance information. If you plan to accept insurance(s) you’ll let your clients know your fee for an intake appointment to ensure they know what to expect during their first session with you. You can also offer to have more detailed information about what is covered by their insurance prior to their initial appointment with you. Some client’s may be eager to begin services, not wanting to wait for pre-authorization for therapy to return from their insurance. If your client is wanting to utilize their insurance, and you’re an out of network provider, I’d advise you to read over the following statement from MMHCA that explains the disclosure statement, and signatures, that are needed.

Providing all new clients with a good faith estimate is also a good practice to get into. It ensures that your client knows what to expect as far as total costs for your services as well as encourages them to seek a better understanding from their insurance company regarding how much their copays are for mental health services (which is sometimes covered under “specialty services” instead of behavioral health), when their deductible restarts, and what providers are considered in and/or out of network.

For additional information, I’d contact your biller or the Michigan Mental Health Counselors Association’s legal counselor - Abby Pendleton, esq. apendleton@thehlp.com. Also, consider joining MMCHA to make sure you receive the most up to date information about issues that effect you as a Michigan LLPC/LPC.

The Michigan State Medical Society published a short article that explains the very basics and may be helpful to read. Link found here.