As a matter of course, Health Assets customers have benefits verified for all new patients and when patients change their coverage during treatment. This is the first step in finding out if a patient is uninsured or you are out of network for this patient.
If the patient is uninsured, and you have a self-pay agreement, you will need to give the patient a Good Faith Estimate (GFE) of what they can expect to pay for your services.
For now, you do not need to provide a GFE to patients who are covered by insurance, and you are not in-network with their plan. We expect that a mandate to provide a GFE to these patients is coming soon.
The estimate will either be the Private Pay rate you have established for uninsured patients or the amount you would charge a health care plan for the service. Health Assets’ billing customers have a fee schedule that we use to submit claims. We can send it to our customers to include in their Good Faith Estimate form.
If you are offering a reduced fee to a particular patient due to their unique circumstances, you must include that information in the patient chart and indicate the agreed upon fee on your GFE.
The timeframe for the GFE is 12 months. For example, “I expect to offer psychotherapy sessions weekly for the year at $150 per session. Considering holidays and vacations, I anticipate 48 sessions for a total of $7200.” If you continue with this patient after the 12-month period, or you change anything listed on the original GFE you will need to give them a new GFE reflecting any changes, such as frequency or per session fee.
Your Estimate must include the Patient’s Name and Date of Birth, Your Name, NPI and Tax ID and location of services. List the typical diagnoses you treat, or the diagnosis you will be using for the specific patient, and the anticipated procedure codes (ask your client representative if you aren’t sure). If you indicate TBD for the diagnosis code, you will need to furnish a new GFE when the diagnosis is established.
The sheet of standard disclaimers to be included with your Good Faith Estimate can be found on the Health Assets website, www.healthassets.com. Go to the Resources tab and Choose “Downloads”.
As always, we are here to help. Call, or email us, to find out how we can take the administrative burden off you so that you can do what you do best – take care of the mental health of your patients.