Good Faith Estimate

Good Faith Estimates

Last updated July 1, 2024

Effective January 1, 2022, a ruling went into effect called the “No Surprise Act” which requires practitioners to provide a “Good Faith Estimate” about out of network care. The Good Faith Estimate strives to show the cost of items and services that are reasonably expected for your health care needs based on your diagnosis, type of treatment, and your clinical needs. 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 may be charged more if complications or special circumstances occur and will be provided a new Good Faith Estimate. 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, health care providers and health care facilities are required to provide a good faith estimate of expected charges for items and services to 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, upon request or at the time of scheduling health care items and services.

Note: The PHSA and GFE does not apply currently to any clients who are using insurance benefits, including Out Of Network Benefits (seeking reimbursement from your insurance companies). 

Good Faith Estimate Public Disclosure

Under the No Surprises Act (H.R. 133 – which went into effect on January 1, 2022), health care providers need to give clients or patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes psychotherapy services.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

  • You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

  • There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

Note: A Good Faith Estimate is for your awareness only. It does NOT involve you needing to make any type of commitment.

Standard Notice – Right to Receive a Good Faith Estimate of Unexpected Charges under the No Surprises Act

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.  Under the law, health care 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 psychotherapy services.

  • Make sure your health care provider gives you a Good Faith Estimate before your service. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (800) 985-3059.