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Good Faith Estimate

“Good Faith Estimate for Health Care Items and Services” Under the No Surprises Act

The No Surprises Act was enacted in 2020 with the goal of protecting patients from unexpected bills for healthcare services, such as charges for out-of-network emergency care. Many of its provisions do not apply directly to mental health providers. However, as per the opinion of APA, and summarized in this article: “Beginning January 1, 2022, psychologists and other mental health care providers will be required by law to give uninsured and self-pay patients a good faith estimate of costs for services that they offer, when scheduling care or when the patient requests an estimate.” 
 Here are some key features of the “good faith estimate” disclosure requirements, as discussed in APA’s article:

New billing disclosure requirements take effect in 2022:

  • The disclosure requirements apply to all healthcare providers, including mental health providers who treat self-pay and/or uninsured patients.

  • Providers must ask about insurance coverage, including whether the patient intends to submit claims to insurance.

  • Providers must inform all self-pay and uninsured patients that a good faith estimate of charges is available.

  • A good faith estimate of expected charges must be given to the patient within specified time frames (e.g., for services scheduled at least 3 days prior to the appointment date, no later than 1 business day after the date of scheduling).

  • The estimate is not binding. However, patients may challenge a bill if the charges substantially exceed the estimated amount.

  • If there are changes to the information in the good faith estimate, a new estimate should be provided.

  • The estimate can include anticipated charges for recurring services that are expected to be provided within the next 12 months (e.g., 10-20 psychotherapy sessions). If treatment continues beyond 12 months, the provider must give the patient a new estimate.

  • These disclosure requirements apply to existing as well as new patients.