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” about out-of-network care. The Good Faith Estimate works to show the cost of items and services that are reasonably expected for your health care needs for an item or service¸ a diagnosis¸ and a reason for therapy. The estimate is based on information known at the time the estimate was created.
The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur and will be provided a new “Good Faith Estimate” should this occur. If this happens¸ federal law allows you to dispute (appeal) the bill if you and your therapist have not previously talked about the change and you have not been given an updated good faith estimate.
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 “Good Faith Estimate” of expected charges. Note: The PHSA and GFE does not currently apply to any clients who are using insurance benefits¸ including “out of network benefits (i.e. submitting superbills to insurance for reimbursement).
Practitioners are required to provide a good faith estimate of expected charges for a scheduled or requested service¸ including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service.” That estimate must be provided within specified timeframes:
- If the service is scheduled at least three business days before the appointment date¸ no
- later than one business day after the date of scheduling
- If the service is scheduled at least 10 business days before the appointment date¸ no later than three business days after the date of scheduling; or
- If the uninsured or self-pay patient requests a good faith estimate (without scheduling the service) no later than three business days after the date of the request. A new good faith estimate must be provided within the specified timeframes if the patient reschedules the requested item or service.
Note: The PHSA and GFE does not currently apply to any clients who are using insurance benefits¸ including “out of network benefits (i.e. submitting superbills to insurance for reimbursement).