Insurance and Fees

No Surprises Act

“The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.”

-CMS.gov

Good Faith Estimate

Beginning 01/01/2022, therapists and other health care providers are required by law to give uninsured and self-pay clients a Good Faith Estimate (GFE) of costs for services that they offer, when scheduling care or when the patient requests an estimate.

A good faith estimate (GFE) is a document that outlines the estimated costs and terms of receiving services from a healthcare provider. This enables clients the opportunity to compare pricing among different providers by giving detailed information regarding services and costs of services received at each provider’s location. The costs noted on the Good Faith Estimate are estimates based on service pricing at the time the estimate is given. The final costs for services may be higher based on when the services are provided and the duration of the services. If this happens, federal law allows you to dispute (appeal) the bill.

The Good Faith Estimate is not a contract. This means you are not required to obtain the items or services provided by Integrative Family Counseling listed in the Good Faith Estimate.

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.

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 the 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 about disputes and get a form to start the process, go to www.cms.gov/nosurprises  or call 1-800-985-3059.

For questions or more information about your right to a Good Faith Estimate or the dispute process,

visit www.cms.gov/nosurprises  or call 1-800-985-3059.