Good Faith Estimate
“No Surprises” Act
-
Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a an insurance plan or coverage or a Federal health care program, or who are 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.
-
The “No Surprises” Act (NSA) was enacted in December 2021 and went into effect January 1, 2022. The act aims to reduce the likelihood that patients may receive a “surprise” medical bill by requiring that providers inform patients of an expected charge for a service before the service is provided.
-
This act currently applies to healthcare providers (including therapists) who are serving clients who are paying either out of pocket or out of network with their insurance company. It is expected to expand in the coming months to include in-network clinicians as well. Meaning, all therapists will eventually have to comply with the new regulations.
Who qualifies as a self-pay client?
A provider’s duty to provide notice and a GFE applies to self-pay patients, i.e., an individual who (1) does not have benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, federal healthcare program, or a health benefits plan; or (2) chooses not to use his or her coverage benefit for the item or service.
In many ways, this regulation protects clients from discovering, after they receive care, that they owe a massive medical bill for un-covered services.
However, therapy is different in that we can’t necessarily provide an estimate of how long it takes to treat a relationship issue, anxiety, depression, and/or trauma. At Healing Ground Counseling, we estimate based on one year at a time. If treatment lasts beyond one year, the GFE will be revised for the following year depending on the estimated duration of treatment.
There are many variables that make it nearly impossible to determine what will be needed for treatment. And there is no way to give a “good faith estimate” on whether or not a client will want to return.
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 related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care 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 health care 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 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.
GOOD FAITH ESTIMATE DETAILS
The fees listed below reflects current session fees:
Established clients have already completed their intake appointments and can disregard the fee for that service.
Individual/Family/Couples Client: Good Faith Estimate
Intake appointment: $200
Follow-up sessions (50 min): $165
Client sees therapist weekly for 48 weeks in calendar year: $7,955
Client sees therapist bi-weekly for 48 weeks in calendar year: $3,995
*This estimate is not a contract. You have the right to dispute charges that are $400 or more than this estimate.
Contact us.
Have questions? Reach out!
eddie@healingground-counseling.com
(385) 325-2624
1458 East 820 North
Orem, UT 84097