01/07/2022
"NOTICE OF THE RIGHT TO RECEIVE A GOOD FAITH ESTIMATE OF EXPECTED CHARGES” UNDER THE “NO SURPRISES ACT”
Effective 01/01/2020
Beginning January 1, 2022, federal laws regulating client care have been updated to include the “No Surprises” Act. This Act requires health care practitioners to provide current and potential clients a “Good Faith Estimate” (GFE) on the cost of treatment.
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.
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.
There are a number of factors that make It challenging to provide an estimate on how long it will take for a client to complete therapeutic treatment, and much depends on the individual client and their goals. While it is not possible for a psychotherapist to know, in advance, how many sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend and your individual circumstances.
• You have the right to receive a GFE 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 GFE 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 GFE before you schedule an item or service.
• If you receive a bill that is substantially in excess of your GFE, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.
During our first consultation, I will verbally provide you with a Good Faith Estimate (GFE). In addition, this estimate will be provided to you in writing.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.
DISCLAIMERS:
•The information provided in the GFE is an estimate. Actual healthcare items, services, or charges may differ or change throughout the year, even for long-term established clients. Clients may request an updated GFE at any time.
•The GFE is not a contract, and does not bind, obligate, or require any client to obtain healthcare services or items from me.
Policies & resources Review rules and fact sheets on what No Surprises rules cover, and get additional resources with more information.
