What is it?

We hear plenty of stories in the news of people getting huge unexpected bills after needed medical procedures. Perhaps you have even experienced this.  One provider, for example, that saw you at a hospital was out of network with your insurance, and you got stuck with a huge fee, or something wasn't covered that you thought was. Or perhaps you don't have insurance, and had to get a procedure done and had no guidance from the start what it all would cost.   

To counter this, as part of the COVID funding bill of Dec 2020, congress enacted a law that requires that all medical providers give “Good Faith Estimates” prior to treatment clearly stating what is being treated (diagnosis and procedure codes) and what the estimated cost and duration of treatment will be.  In other words, you now have the right to  receive a “Good Faith Estimate” explaining how much your medical care will cost.

Who’s it for?

Right now, it only applies to services that are provided out of network, either as an out of network provider (providing a Superbill) or if you do not have (or choose to use) your insurance.

What's it say?

Under the law, health care providers need to give you an estimate of the bill for medical items and services. You have the following rights under this law:

• You have the right to receive a Good Faith Estimate (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.

• Your health care provider must provide a GFE in writing at least 1 business day before your medical service or item. You can also ask  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 GFE, you can dispute the bill, so make sure to save a copy or picture of your Good Faith Estimate.

How does this apply to mental health?

Unlike many medical procedures, mental health treatment is often an ongoing service and it can be hard to estimate how long treatment will take. Many factors are at play, including everyday life problems, that impact outcome in therapy, and sometimes treatment go quickly, while other times, it can take a while. And before treatment starts, we often don't have a diagnosis code, so it is hard to determine how long treatment will take.

Because of this, your Good Faith Estimate first be based on a year of services. And remember, it is only an estimate.  Treatment planning is often a part of the first few sessions of treatment, and we can discuss then how long treatment may take. We will continue to reassess this as treatment continues, so we may update your GFE as needed.  

Want to find out more?

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