Good Faith Estimates: What You Should Know

As of January 1, 2022, there is a new law called the No Surprises Act that requires all health care providers to give clients who don’t have insurance or are not using insurance an estimate of the bill for medical items and services they are to receive because the provider is out-of-network for their benefits.

“Surprise billing” is when you receive a bill with an unexpected balance. This can happen when you cannot control who is involved in your care, such as when you have an emergency hospitalization and a service is provided by an out-of-network provider at an in-network facility.

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. In the case of mental health, it refers to the number of sessions you are likely to have with your mental health professional (a licensed social worker, mental health counselor, marriage and family therapist or clinical psychologist).

Your health care provider should give you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care 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.

Make sure you save a copy or picture of your Good Faith Estimate.

If you are a client of my practice, you will have been sent a Good Faith Estimate through the client portal. To view and acknowledge receipt of your Good Faith Estimate, log into your client portal. Your Good Faith Estimate was created based on our current meeting frequency and your session rate but may likely be overestimated, in order to provide you the maximum amount of out-of-pocket expenses for treatment. If additional services are recommended, your Good Faith Estimate will be revised to reflect the change. The estimated costs are good for 12 months after the date of the Good Faith Estimate.

Remember, this is not a bill. If you do not have as many sessions this year as are listed in the estimate, then your costs will be lower than estimated. The Good Faith Estimate includes additional information about your rights and how to learn more. And as always, feel free to reach out to me with any questions you may have.

For more information about your right to a Good Faith Estimate or how to use the dispute resolution process, you can visit www.cms.gov/nosurprises or call 1-800-985-3059.

** The No Surprises Law has already seen several revisions, so it is subject to change. This document on the CMS website currently has an expiration date of 3/31/22.

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