Good Faith Estimate

Background

• The No Surprises Act was passed on December 2020, under Section 2799B-6 of the Public Health Service Act, with the aim of protecting consumers from receiving unexpected medical bills. 

• The Good Faith Estimate provision of the No Surprises Act federally mandates that healthcare providers must give clients, who do not have insurance or who are not using insurance, an estimate of anticipated healthcare items and services, using what is called a “Good Faith Estimate.” This took effect on January 1, 2022.

• This new regulation is designed to provide transparency to patients regarding their expected medical expenses and to protect them from surprises when they receive their medical bills. It allows patients to understand how much their health care will cost before they receive services.

What is a Good Faith Estimate?

A Good Faith Estimate is an estimate of the total expected costs of non-emergency healthcare items or services.

• Intends to offer predictability and transparency in how much clients will be charged for healthcare services prior to their appointment.

• Includes all regularly scheduled appointments (i.e. therapy sessions).

• 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.

• 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.

One Therapy and Consulting offers Good Faith Estimates for 12 months of services. Essentially, your estimate will give you a reasonable idea what to expect in terms of therapy costs for one calendar year, based on current rates. 

What are your rights as a client?

• ​You have the to receive a "Good Faith Estimate" explaining how much your healthcare will cost. Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• 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.

• Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare 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 have a right to dispute the bill. The federal government offers a dispute resolution process for this purpose.

• 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 or call ​800-985-3059.

What considerations should clients keep in mind?

• The information provided in the Good Faith Estimate is only an estimate. Actual healthcare items, services, or charges may differ or change throughout the year, even for established clients. 

• The Good Faith Estimate is not a contract, and does not bind, obligate, or require any client to obtain healthcare services or items from One Therapy and Consulting at any time.

• There are no federal provisions allowing clients to waive their right to a Good Faith Estimate at this time. As such, One Therapy and Consulting is required by law to send all ongoing clients a new Good Faith Estimate every 12 months. Clients cannot opt-out of receiving a Good Faith Estimate and are required to acknowledge receipt and understanding of each new Good Faith Estimate in order to comply with federal law so that we may continue working together.

We are happy to answer questions you may have about the Good Faith Estimate.