Good Faith Estimate
Effective January 1, 2022, a ruling went into effect called the “No Surprises Act”, which requires practitioners to provide a “Good Faith Estimate” to individuals who do not have insurance or who are not using insurance. Under Section 2799B-6 of the Public Health Service Act (PHSA), health care providers and health care facilities are required to inform individuals who 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 GFE of expected charges. The Good Faith Estimate (“GFE”) works to show the cost of services that are reasonably expected for your mental health care needs. The estimate is based on information known at the time the estimate was created.
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 arise and you will be provided with a new GFE should this occur. If this happens, federal law allows you to dispute (appeal) the bill if you and your provider have not previously talked about the change and you have not been given an updated GFE.
Note: The PHSA and GFE do not currently apply to any individuals who are using insurance benefits, including “out of network benefits” (i.e., submitting superbills to insurance for reimbursement).
Timeline Requirements
Providers are required to provide a GFE of expected charges for a scheduled service, including services that are reasonably expected to be provided in conjunction with such scheduled service. That estimate must be provided within specified time frames:
- For appointments scheduled three or more business days before the appointment date, the GFE will be provided within one business day after scheduling.
- For appointments scheduled 10 or more business days before the appointment date, the GFE will be provided within three business days after scheduling.
- A new GFE must be provided, within the specified time frames, if the individual reschedules the requested service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.