The No Surprises Act
Good Faith Estimates
At Rising Lotus Counseling, we want to ensure that patients are fully informed about the costs of their therapy services. On January 1, 2022, the No Surprises Act went into effect. The No Surprises Act does three main things:
Prohibits balance billing or surprise billing (i.e., when a health care provider bills a patient for the difference between the amount the provider charges and the amount the insurance pays) for out-of-network providers in an in-network facility
Requires a good faith estimate (GFE) of expected costs before scheduled services for uninsured and self-pay clients
Ensures continuity of care and accuracy of provider directories
Medical service providers, including therapists, are now required to provide patients with a standardized Good Faith Estimate (GFE) of their healthcare costs. The No Surprises Act ensures that patients cannot balance billed for unexpected healthcare expenses.
A Good Faith Estimate is created based on information known at the time the estimate is first created. It outlines the fees associated with the therapy services being provided, providing transparency into the healthcare process. However, it does not include unknown or unexpected expenses that may arise during the course of treatment.
If you are billed for more than stated in your Good Faith Estimate, you have the right to dispute the bill.
Throughout your treatment, the provider may recommend additional items or services as part of your treatment that are not reflected in this estimate. These would need to be scheduled separately with your consent and the understanding that any additional service costs are in addition to the Good Faith Estimate.
If your needs change during treatment, your provider should supply a new, updated Good Faith Estimate to reflect the changes to treatment, and the accompanying cost changes.
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.
The Good Faith Estimate is not a contract between provider and client and does not obligate or require the client to obtain any of the listed services from the provider.
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.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 985-3059. 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.
Keep a copy of your Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.