GOOD FAITH ESTIMATE

NO SURPRISES ACT/GOOD FAITH ESTIMATE

Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals that are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.

WHAT IS A GOOD FAITH ESTIMATE?

A Good Faith Estimate is an estimate of the total expected costs of non-emergency healthcare items or services.  

  • Intends to offer predictability and transparency in how much clients will be charged for healthcare services prior to their appointment.

  • Under the law, healthcare providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.  This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. This includes all regularly scheduled appointments (i.e., therapy sessions).

  • Does NOT include no-shows, late cancellations, or other services related to crisis care, which by definition are unexpected and cannot be predicted for the purpose of compiling a Good Faith Estimate in advance.

  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.  You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

In my practice, I offer Good Faith Estimates upon request that project out 12 months in advance.  Essentially, your estimate will give you a reasonable idea of what to expect in terms of therapy costs for one whole year, based on my current rates and the frequency of sessions that we mutually agreed upon in advance.  Make sure to save a copy or picture of your Good Faith Estimate.  For questions about the dispute process or for more information about your right to a Good Faith Estimate, please visit www.cms.gov/nosurprises.