No Surprises Act
No Surprises Act & Good Faith Estimate
Under Section 2799B-6 of the Public Health Service Act: www.cms.gov/nosurprises
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.
Providers and facilities must:
Provide the good faith estimate before an item or service is scheduled, within certain timeframes.
Within 3 business days of an appointment scheduled;
If a good faith estimate is requested, it must be provided within 3 business days.
Offer an itemized list of each item or service, grouped by the provider or facility offering care. Each item or service has to have specific details, like the health care code assigned to it and the expected charge.
Explain the good faith estimate to you over the phone or in-person if you request it, and then follow up with a written (paper or electronic) estimate.
Provide the good faith estimate in a way that’s accessible to you.
Once you receive a good faith estimate from your provider or facility, be sure to keep it in a safe place so you can compare it to any bills you get later. View an example of what a good faith estimate (PDF) may include . If you’ve had your service and find that the billed amount is at least $400 above the good faith estimate, you may be eligible to start a patient-provider dispute resolution process. Learn more about the dispute resolution process, including eligibility requirements and what information or documents you need to start a dispute. The cost to get the dispute process started is $25.
Healthcare providers are required to provide clients who do not have insurance or who choose not to use their insurance for therapy services with an estimate of the cost of those services. The total cost for each client will vary depending upon the length of time and frequency of sessions that occur throughout the therapeutic relationship as determined by the initial assessment and continued evaluation of treatment needs and progress. A detailed list of possible services is provided. This estimate will be valid for the next twelve (12) months. Should any fee changes occur, or upon your request, The Center For Relationships will provide you with a new good faith estimate.
https://www.cms.gov/nosurprises
https://www.cms.gov/nosurprises/consumers/complaints-about-medical-billing
The information provided here is for general informational purposes and not intended to serve as legal advice or opinion.