A provider’s duty to provide notice and a GFE applies to self-pay patients, i.e., an individual who (1) does not have benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, federal healthcare program, or a health benefits plan; or (2) chooses not to use his or her coverage benefit for the item or service.

In many ways, this regulation protects patients from discovering, after they receive care, that they owe a massive medical bill for un-covered services. This makes sense from a medical point of view – we have all heard the horror stories of a patient going bankrupt after discovering their insurance doesn’t cover some services or providers. For example, if an out-of-network provider gives post-surgical care at an in-network hospital, the patient could end up with a big out-of-pocket expense that comes as a complete surprise.

However, therapy is a little different in that we can’t necessarily provide an estimate of how long it takes to treat a relationship issue, address anxiety, make a plan for parenting, focus on and minimize depression, etc. There are a number of variables that make it nearly impossible to quantify what will be needed. And there is no way to give a “good faith estimate” on whether or not a client will want to return for a “tune-up”

I have made several attempts to get clarification on how this affects therapists and therapy clients and been unsuccessful. In an abundance of caution and in keeping with my policies of general transparency, I am posting this notice.