You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.
As of January 1, 2022, the “No Surprises Act” requires all healthcare providers, including mental health practitioners, to give patients 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, an estimate of their bill for health care items and services before those items or services are provided. This estimate, called a Good Faith Estimate (GFE), is based only on information known at the time the estimate was created; it does not include any unknown or unexpected costs that may arise during treatment. Federal law allows you to dispute or appeal a bill if you have not been provided a GFE.
Under this statute, providers are not required to provide GFEs to individuals insured under Medicare, Medicaid, or other federal health care programs, or to any individuals who are using insurance benefits, including “out of network benefits”.
The No Surprises Act also mandates that a GFE is provided within certain timeframes:
- If you schedule a healthcare service at least 3 business days in advance, the GFE must be provided within 1 business day after scheduling.
- If you schedule a healthcare service at least 10 business days in advance, the GFE must be provided within 3 business days after scheduling.
- If you choose not to schedule the service but request a GFE, it must be provided within 3 business days of the request. A new GFE must be provided within the above timeframes if you later schedule the service.