Right to a Good Faith Estimate 

 

Effective January 1, 2022, a ruling went into effect called the “No Surprises Act,” which requires practitioners to provide a “Good Faith Estimate” to clients.  This currently impacts those practitioners who work with clients who have elected to work with a practitioner under a self-pay model.

 

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.

Under the law, health care providers need to give patients who are not using insurance to pay for their services an estimate of the expected charges for medical services, including psychotherapy services.  

 

You have the right to receive a Good Faith Estimate for the expected cost of any non-emergency healthcare services, including psychotherapy services.  You can ask your health care provider for a Good Faith Estimate if you are seeking services with that provider.  You are encouraged to save a copy of any such Good Faith Estimate for future reference.   

 

While it is not possible for a psychotherapist to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, the Good Faith Estimate should provide an estimate of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual circumstances, and the type and amount of services that are provided to you. The Good Faith Estimate is not a contract and does not obligate you to obtain any services from the provider(s) listed within the Good Faith Estimate, nor does it include any services rendered to you that are not identified directly within the Good Faith Estimate.  

 

The Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with your therapist.

 

The Good Faith Estimate is based on information known at the time the estimate was created.  The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment.  You could be charged more if complications or special circumstances occur and if your original Good Faith Estimate does not reflect the fees associated with any such circumstances, you should be provided a new Good Faith Estimate should this occur.  If your provider’s fee changes, you should also be provided a new Good Faith Estimate to reflect your provider’s updated fees.    

 

You are encouraged to speak with your provider at any time about any questions you may have regarding your treatment plan, or the information provided to you in your Good Faith Estimate.  If your billed charges are substantially higher than the most recent Good Faith Estimate, you may contact your provider with any related questions.  You may also ask your provider to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.  

 

In the event that you are not able to resolve any such substantial discrepancy between that which was outlined in your most recent Good Faith Estimate and that which you are billed directly with your provider, you have a right to initiate a dispute resolution process.  This resolution dispute process is an option if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges).  If you choose to pursue this option, you may 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 the Good Faith Estimate.  If the agency disagrees with you and agrees with the health care provider, you will have to pay the higher amount.  

 

For questions or more information about your right to a Good Faith Estimate, please visit www.cms.gov/nosurprises.

 

Please also contact your health care provider if you have any questions or concerns about your right to a Good Faith Estimate.  

Contact Us

 

We welcome your questions or comments regarding your right to a Good Faith Estimate:

Sage Windemaker, LCSW, LLC

330 Kennett Pike Suite 205B

Chadds Ford, PA 19317

Email Address: info@sagewindemaker.com
 

Effective as of January 1, 2022