Good Faith Estimate Under the No Surprises Act

Under the No Surprises Act, healthcare providers are required to inform patients who are uninsured or choosing not to use insurance about their right to receive a Good Faith Estimate of expected healthcare costs. This federal law, effective January 1, 2022, protects consumers from unexpected medical bills and ensures transparency in healthcare pricing.

A Good Faith Estimate explains the anticipated charges for your medical or mental health services before you receive care. It is not a bill, but rather a projection based on the information your provider has at the time of scheduling. This allows you to make informed financial decisions and compare costs if needed.

Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate for the total expected cost of non-emergency healthcare services, including psychotherapy and mental health treatment. This right applies regardless of whether you are completely uninsured or simply prefer to pay out of pocket without involving your insurance plan.

Healthcare providers must provide this estimate to patients who:

• Do not have health insurance, or
• Choose not to use their insurance for services

This estimate helps you understand potential costs before scheduling or receiving care. For example, if you are beginning a series of therapy sessions, the Good Faith Estimate will list the per-session fee, the expected number of sessions over a specific period (often 12 months), and any additional charges such as administrative fees or psychological testing.

You have the right to request a Good Faith Estimate from any healthcare provider, including primary care physicians, specialists, mental health therapists, dentists, physical therapists, and outpatient surgical centers. The provider is legally obligated to respond to your request in a timely manner.

What the Estimate Includes

A Good Faith Estimate may include expected charges for:

• Therapy sessions (individual, family, or group)
• Mental health services, including diagnostic assessments and follow-up care
• Other related healthcare services provided by your provider, such as laboratory tests, imaging, or procedures
• Facility fees if the service is performed in a clinic or hospital setting
• Any reasonably anticipated additional services based on your initial diagnosis or treatment plan

You may request this estimate before scheduling an appointment. Under the law, if you request a Good Faith Estimate and your appointment is scheduled at least three business days in advance, the provider must give you the estimate no later than one business day before your appointment. For services scheduled further out, the estimate must be provided within three business days of your request.

When a Good Faith Estimate Is Not Required

There are important exceptions. You are not entitled to a Good Faith Estimate for emergency services, such as emergency room visits or ambulance transportation. Additionally, if you choose to use your health insurance and see an in-network provider, your cost-sharing responsibilities (copays, deductibles, coinsurance) will be determined by your insurance plan rather than a Good Faith Estimate.

If Your Final Bill Is Higher Than Expected

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the charge. This is a powerful consumer protection. To start a dispute, you should first contact your provider to discuss the discrepancy. Many billing errors can be resolved at this stage.

If the issue remains unresolved, you can initiate a Patient-Provider Dispute Resolution (PPDR) process through the Centers for Medicare & Medicaid Services (CMS). You do not need to pay the disputed amount while the review is pending. An independent dispute resolution entity will review your case, including your Good Faith Estimate and the final bill, and determine a fair payment amount.

It is important to keep a copy of your Good Faith Estimate for your records, along with any receipts, billing statements, and written communications with your provider. These documents will be essential if you need to file a dispute.

How to Protect Your Rights

To make the most of your rights under the No Surprises Act, follow these steps:

• Always request a Good Faith Estimate in writing before your first appointment.
• Store your estimate in a safe place alongside other medical paperwork.
• Compare your final bill carefully to the estimate as soon as it arrives.
• If you see a discrepancy of $400 or more, contact your provider promptly.
• Do not ignore unexpected bills — use your dispute rights within the allowed timeframe (typically 120 days from the date of the bill).

Learn More About Your Rights

For additional information about your rights under the No Surprises Act, including sample dispute forms and frequently asked questions, visit:
http://www.cms.gov/nosurprises

You may also call the CMS helpline for patient support:
(800) 985-3059

Understanding your right to a Good Faith Estimate empowers you to avoid unexpected medical debt and seek care with confidence. Do not hesitate to ask your provider for this document — it is your legal right, not a courtesy.