Good Faith Estimate (No Surprises Act)

Under the No Surprises Act (H.R. 133 – effective January 1, 2022), health care providers are mandated to give clients who do not have insurance or who are not using insurance an estimate of the bill for medical items/ services. It aims to offer predictability & transparency in how much clients will be charged for healthcare services prior to their appointment, and includes the fee for all regularly scheduled appointments. It will also include additional provider notes on fees and practice policies, such as fees related to paperwork requests, and other legal and administrative fees related to client care. It does not include no-shows, late cancellations, or any other services related to crisis care, which by definition are unexpected and cannot be predicted for the purpose of compiling a Good Faith Estimate. You may experience additional charges if complications or exceptional circumstances occur. Make sure to save a record of your Good Faith Estimate.In my practice, I offer Good Faith Estimates that project out 12 months in advance. Essentially, your estimate will give you a reasonable idea what to expect in terms of therapy costs for one year, based on my current rates and the frequency of sessions that we mutually agree upon in advance. If my fee is to change within the 12 month time frame, I will notify all clients at least 30 days prior to the change taking effect.

Client Rights

I support each and every client in knowing their rights as pertains to the No Surprises Act. In addition, the Good Faith Estimate offers specific protections:

  1. You have the right to receive a Good Faith Estimate even if you get superbills from me, since I am not in-network with all insurances.

  2. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare service or items.

  3. You have the right to receive your Good Faith Estimate in writing at least 1 business day before your scheduled healthcare service or item. If a service is scheduled at least 10 business days in advance, the Good Faith Estimate must be provided within 3 business days (of the scheduling, not of the appointment itself). If a service is scheduled at least 3 business days in advance, the Good Faith Estimate must be provided within 1 business day of scheduling.

  4. You have the right to request a Good Faith Estimate before you schedule a healthcare service or item. For services scheduled less than 3 business days in advance, please note that a Good Faith Estimate is not required by federal law, and will not be provided for you in written form except by request.

  5. You have the right to receive a requested Good Faith Estimate within 3 business days.

  6. You have the right to dispute a bill that exceeds your Good Faith Estimate by $400 or more. The federal government offers a dispute resolution process for this purpose. If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about four months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this GFE. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

Disclaimers

The information provided in the Good Faith Estimate is only that: an estimate. Actual healthcare items, services, or charges may differ or change throughout the year, even for long-term established clients. For new clients, I may revise your estimate once we have met and discussed more details around your symptoms, likely diagnoses, severity, and treatment plan, which may not be reflected in the Good Faith Estimate you initially receive. However, I will never schedule healthcare services or items without client consent, and clients may request an updated Good Faith Estimate at any time.

The Good Faith Estimate is not a contract, and does not bind, obligate, or require any client to obtain healthcare services or items from me at any time. 

There are no federal provisions allowing clients to waive their right to a Good Faith Estimate at this time. The regulation allows clients to waive some of the protections related to balance billing, but does not allow me as a therapist to bypass the Good Faith Estimate through a client waiver. As such, I am required by law to send all ongoing clients (or legal guardians if the client is a minor) new Good Faith Estimates every 12 months or as rates change. Clients cannot opt-out, and are required to acknowledge receipt and understanding of each new Good Faith Estimate in order to comply with federal law so that we may continue working together.