The Federal No Surprises Act is intended to protect you from surprise medical bills and make it easier for you to understand the costs of health care services before you get a service. Medical providers should provide you with a "Good Faith Estimate" before you agree to receiving treatment that should include: all of your diagnoses, the type of services that you will need, the schedule of those services, the number of times you will need to receive the treatments/services, the total duration of your treatment, and total estimated cost when all treatments are said and done. 

  • It can take up to a few sessions to make a proper diagnosis. Any diagnosis made during an initial phone consultation is likely NOT a proper or ethical diagnosis.
  • This rule forces the medical model of making a diagnosis, AND DOCUMENTING IT IN A LETTER TO YOU AT THE ONSET OF THERAPY. 1) Not all therapists are "medical model" therapists; their work is going to look very different than this right from the start. They do not even speak in diagnostic terms. They discuss behaviors and seek to understand the reasons for the behaviors and do not see them as "disorders." 2) There are times when it is wise for a therapist to hold off sharing a diagnosis with you, particularly when it is going to be difficult for you to hear and the rapport between you and your therapist has not yet been established. You may need support from your therapist when you receive that information, but that support will only feel supportive AFTER the therapist has worked to earn your trust. Having a rule in place that forces your therapist to disclose a diagnosis BEFORE treatment even begins might cause you to want to run from the therapy that you want and need after you have worked so hard to get the courage to seek it in the first place. And again, some therapists are not medical model therapists and DIAGNOSING SOMEONE FROM A 15-MINUTE PHONE CONVERSATION IS LIKELY AN UNETHICAL AND INACCURATE DIAGNOSIS.
  • Treatment planning in therapy should be a joint effort between you and your therapist that happens within the first few sessions while the rapport between you and your therapist is still developing. The plan should be based upon your goals for therapy but what if you don't know what your goals are yet? People often seek therapy because they know they are in need of help or support, but they certainly are not thinking about "treatment goals!" Many of my clients have become downright pissed off at the very mention of a "treatment plan" because in that moment, I had just clinicalized their tragidy and they had every right to be pissed. How dare I 1) disconnect from something so emotional in such a cold way, and 2) think about a piece of paper and an obligation to...WHO?...WHAT?... right now!
  • Regarding the schedule of the services, there are many reasons why your schedule for therapy might change, and possibly, many times. Those reasons could come from you or your therapist. We also learn the schedules through trial and error. You might find that you do a lot better coming weekly because you need that consistancy, or you might do worse coming weekly because you need more time to process things and try to do the skills on you own between sessions. We would be changing that letter so much due to the number of times that we would be changing the schedule of the treatments.
  • There is NO WAY we can estimate the number of times you will need to receive the services, the total duration of your treatment, and total estimated cost when all treatments are said and done! There is a HUGE difference between GOING TO therapy (physically showing up) and BEING IN therapy (fully engaging in therapy, allowing yourself to be vulnerable, and actually doing the work between sessions)! Some people go to therapy for a very long time and have not spent a moment actually BEING IN therapy and that process CAN NOT BE RUSHED; it takes much patience, trust, courage, and willingness to get there! Once you finally do fully engage in therapy, we still have no clue how long it will take because every situation is different and we can not predict what else will come up for you, what will speed things along, or what might completely derail you during therapy. I had a client come in for an evaluation convinced that he would be in therapy for 3 sessions tops and stayed for 3 years.  I had someone else tell me early on in his therapy that he knew that he would be seeing me for the rest of his life if I worked that long because has been in therapy for as long as he could remember and he didn't see it ever changing. He successfully completed therapy after 4 years and some change. It is just not possible to predict this the way we can predict how long it will take for an infection to clear up or a broken bone to set. Therapy is too nuanced.

Ways In Truth MHC Addresses This

  • In Truth MHC attempts to be as transparent as possible about the costs of care with potential and current clients given all the nuances that make it just about impossible and nearly, if not actually, unethical to provide the Good Faith Estimate as required.
  • We provide initial phone consultations that can last anywhere from 15-45 minutes. We do NOT charge for these phone calls regardless of the length of the call or whether or not you sign up with us. During that call:
  • We will notify you that we do NOT take insurance and we will offer the option to allow us to give you contact information for therapists that do take your insurance if you are unable to pay out of pocket to work with us.
  • We will notify you of your option to check with your insurance company to see if you are eligible for at least a partial reimbursement for therapy while keeping in mind that it would require us to put a diagnosis on your chart. Doing so does go against our therapy model, however, we ARE qualified and willing to do so. We would provide a statement of payment called a "superbill" that you would submit to your insurance for reimbursement. We strongly recommend that you call them prior to signing up with us if you need the reimbursement in the event they decline the request. 
  • We will notify you what your session rate will be (we use a sliding scale based on household income and household size) and whether we would recommend that you attend weekly or every other week before we agree to take you on as a client so that you can determine if this is affordable for you. You are more than welcome to ask us to quickly do the math over the phone of what your ESTIMATED cost would be per month and per year given the frequency you and your therapist agree upon. We just can not tell you the total length of time you will need to be in therapy with us for you to meet your therapy goals. Regarding schedule of care, you have the right to schedule with us every 2 weeks even if we recommend weekly. We will notify you that we do not allow new clients to schedule less frequently than once every 2 weeks but once you have established a good therapeutic relationship with your therapist and your struggles seem to be more manageable to you, you can talk with your therapist about coming less frequently.
  • We do NOT engage in contracts! You are free to leave therapy whenever you want, even if your therapist disagrees with your decision. All we ask is that 1) YOU PAY WHAT IS OWED TO US FOR SERVICES RENDERED AND 2) You don't "ghost" us. Have a conversation with your therapist about wanting to end therapy. If you need to end therapy with us due to finances, PLEASE TELL US! In that event, your therapist MUST provide you with contact information for a therapist who takes your insurance and can take you on as a client. If you just leave and cut off contact, we will be unable to help you find a therapist that you can afford. WE NEVER TAKE IT PERSONALLY when you need to find a therapist due to finances. Please, let us help you in those situations!
  • Each therapist is allowed to offer one half-rate slot. We reserve those slots for clients who are on Medicaid or Medicare and there is usually a waitlist for them. You may ask your therapist about this if you are on Medicaid or Medicare. You will be asked to present your card or number as proof.
  • We will notify you during the first phone consultation of our payment and cancelation policies and we provide you with the opportunity to ask questions about that. We will also send you a very comprehensive document outlining all of our policies including payment, scheduling, and length of therapy matters in our "Full Disclosure/Informed Consent" document. We will NOT work with anyone who does not agree to follow our practice policies. 
  • WE WILL NOT DIAGNOSE YOU DURING AN INITIAL CONSULTATION PHONE CALL! EVER. PERIOD. IDGAF WHAT ACT, LAW, RULE SUGGESTION, ETC. SAYS! Should you request a diagnosis, OF COURSE, you and your therapist will have a discussion about this. She will ask your motivation for wanting to know to be sure that she can be as supportive as possible when she provides that information for you. Although In Truth MHC does not agree with the medical model's way of pathologizing, there may be times when your therapist will be the one to initiate the discussion of a diagnosis. 
  • Regarding treatment planning: Your therapist will not be able to tell you a comprehensive treatment plan over the phone during your consultation phone call. A plan for how we will tackle the issues you come to address will be worked out in the first few sessions with you as you start to untangle everything you came to discuss with your therapist. If you have therapy goals that seem unreasonable to your therapist (such as trying to change someone else's behaviors), your therapist will discuss this with you. During that treatment planning, WE DO ENTER TIME FRAMES that are rather short such as "over the next 6 months, we will be _____." We do also include types of therapy on the treatment plan as well as schedule of therapy such as "every 2 weeks."

Internet Links/Resources

The Reasons Why This Is Difficult For Therapy

No Surprise Act/Good Faith Estimates