No Surprises in California

California says no surprises in health care bills! The state is working to make it easier for clients to understand the cost of health care. A new state law began in 2022 that requires health care providers to give clients without insurance or are paying out of pocket a good faith estimate of costs associated with treatment. This must also be provided if requested.

The No Surprises Act states that the estimated cost must address the price of services based on clinician knowledge at the time they provide the estimate. The client must also receive the estimate three days before the first time they are charged. The client has the potential to dispute their bill if costs are $400 or more over the estimate.

Pros: The law does allow you to amend cost estimates. The best way to avoid repercussions is to provide a new estimate any time the original treatment changes. This law gives us a window to openly discuss costs with our clients. They also provided some handy-dandy templates to guide us!

Limits: Sound weird to anyone? The Act was intended to provide consumer protections for medical treatment, but mental health requires a lot of flexibility in treatment. For instance, a client starts out once a week, but a major stressor occurs, so they request to increase sessions to twice a week. This would mean that the original estimate provided is no longer accurate due to the increase in the unit of treatment. This can pose a real challenge for mental health providers.

All providers work hard to provide the best treatment for our clients. The law provides extra protection, but can also affect compensation to provider for hours worked. Being able to understand the ins-and-outs of the law can help providers in California navigate it. But keep an eye out in case a similar act surprises you in your state!