No Surprises Act

Federal Protections That Protect Mental Health Patients

 
 

Effective January 1, 2022, federal law now requires mental health providers like us to be more transparent and proactive in helping you understand anticipated costs for treatment. In compliance with this law, Breakwater Psychotherapy maintains the following practices:

No Balance Billing

Sometimes insurance companies will choose to reimburse a service provider (like Breakwater) for less money than the provider charges for the service that was provided. In some instances, providers used to charge the remaining difference in charges to the client directly.  This practice is called balance billing and is now prohibited as a general rule.  As an operating principle, Breakwater Psychotherapy does not balance bill clients.  There are some situations in which we may seek additional reimbursement for uncovered costs, but never without your prior awareness and consent to do so.

Your Right to File a Complaint

Breakwater prioritizes transparency and informed consent for all charges and billing practices. As part of our accountability to these priorities, you have a right to file a complaint if you feel your service charges have been unfairly totaled or credited.  If you have any complaints about your medical bills you can:

Your Right to a Good Faith Cost Estimate

Breakwater is willing and able to provide a good faith estimate of the total anticipated cost of services by request.  To this end, and as described in the informed consent documents, we ask you to review before entering services, the very nature of quality therapeutic services makes them difficult to predict or estimate fully.  At Breakwater, we abide by ethical principles and guidelines to inform the duration and direction of treatment depending on your presenting concern.

Broadly speaking, we assume a typical psychotherapy treatment lasts between 8-12 sessions including the intake assessment, treatment planning, and (hopefully satisfactory) resolution of concerns through agreed-upon follow-ups.  With our pricing, that means you can reasonably expect that a full course of treatment for most concerns usually costs between $1500 and $2500 depending on the complexity and length of treatment.

Your Right to Continuity of Care

If you establish mental health care at Breakwater that is covered by some third-party payor (i.e. a healthcare plan) with whom Breakwater has a contractual agreement to reimburse for service charges, and if at some point during your treatment that contract is discontinued, Breakwater will make reasonable efforts to ensure you have continuity of care.

This may include (but is not limited to or necessarily involving):

  • Notifying you of such changes ahead of time (if possible) to provide opportunity and assistance in finding another provider who could offer you adequate services and with whom you can use your existing third-party payor

  • Maintaining your services as agreed upon/defined by the former contractual agreement, even when that agreement is no longer valid

  • Continuing your services and charging you for the same amount you were paying while receiving services covered by your third-party payor