Good Faith Estimate:
Right to Receive a Good Faith Estimate of Expected Charges Under the No Surprises Act
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under Section 2799B-6 of the Public Health Service Act, mental health care providers are required to provide a “Good Faith Estimate” (GFE) to individuals not enrolled in an insurance plan or who plan to use their out of network benefits. A good faith estimate enumerates the expenses you can reasonably expect to pay for psychotherapy services provided.
A GFE must be furnished within 1 business day of scheduling an appointment. If you schedule an appointment at least 10 business days in advance, you are entitled to receive the GFE within 3 business days after scheduling. A GFE must be provided within 3 business days UPON REQUEST.
A GFE shows the costs of non-emergency psychotherapy services that are reasonably expected for your mental health needs and the estimate is based upon information known at the time the estimate was created.
A GFE 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.
A GFE may also include consultations with client collateral contacts, fees related to paperwork requests, and other legal and administrative fees related to client care, when such items are scheduled in advance.
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.
As the GFE does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, and your bill is $400 or more than the GFE, federal law allows you to dispute the bill with the Department of Health and Human Services. You must start the dispute process within 120 calendar days of the date on the original bill. There is a $25 fee to use the dispute process.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit:
www.cms.gov/nosurprises/consumers
email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.