The No Surprises Act aims to protect consumers from unexpected medical bills. Beginning January 1, 2022, healthcare providers are mandated to provide patients, who are uninsured or who are insured but do not choose to use their insurance benefits to pay for healthcare services, with an estimate of the bill for non-emergency healthcare items and services. This is called a Good Faith Estimate (GFE), which is a provision under the No Surprises Act. This new regulation aims to provide transparency to consumers regarding how much they will be charged for anticipated non-emergency healthcare services before their appointment and to protect them from surprises when they receive their healthcare bill.
Receive a Good Faith Estimate for the total expected cost of non-emergency healthcare items or services. In my practice, I typically provide a GFE that projects costs 12 months out based on my rates at the time and the frequency of sessions that we mutually agree upon. This includes all regularly scheduled appointments (e.g., weekly therapy sessions) and any items or services scheduled in advance (e.g., consultations with authorized collateral contacts; fees related to preparation of reports or treatment summaries). This does not include no-shows, late cancellations, or other services related to crisis management, which are unexpected by definition and therefore cannot be predicted for the purpose of projecting costs in a GFE.
Receive a Good Faith Estimate in writing within these specified time frames:
Within one business day after the date of scheduling (not of the appointment itself) if the service is scheduled at least three business days before the appointment date.
Within three business days after the date of scheduling if the service is scheduled at least ten business days before the appointment date.
If a service is scheduled less than three business days in advance, a GFE is not required.
Request a Good Faith Estimate before you schedule a healthcare item or service, which you will receive within three business days after the date of request.
Dispute a bill that you receive that is at least $400 more than your Good Faith Estimate.
Please make sure to save a copy or picture of your Good Faith Estimate when you receive it.
A Good Faith Estimate is only that: An estimate. There are a number of factors to consider when estimating how long it will take for you to complete therapy, such as the type of diagnosis/diagnoses, the severity of symptoms, your goals for therapy, etc. The actual healthcare items, services, or charges may differ or change throughout the year as life circumstances and needs may change. If there is any change to the information provided in a GFE, a new estimate will be provided no later than one business day before the appointment date. No healthcare items or services will be scheduled without your consent and you may request an updated GFE at any time.
A Good Faith Estimate is not a binding contract. It does not obligate or require you to obtain any of the listed healthcare items or services from me at any time.
I am required by law to send all ongoing clients new Good Faith Estimates every 12 months. There are currently no provisions in the federal regulation allowing clients to waive their right to a Good Faith Estimate. As a result, clients cannot opt out of receiving a GFE and are required to acknowledge that they have received and understood each new GFE that is furnished.
If you have more questions about Good Faith Estimates and need more guidance, you can learn more at: https://www.cms.gov/nosurprises.