RESOURCES

Good Faith Estimate & No Surprises Act 2022

According to the American Psychological Association, beginning January 1, 2022, psychologists and other health care providers (therapists/counselors) will be required by law to give uninsured and self-pay patients a good faith estimate (GFE) of costs for services that they offer, when scheduling care or when the patient requests an estimate. 


Under the
No Surprises Act, all uninsured and self-pay clients will be given a good faith estimate of expected charges provided by one of the
following methods 


a.       
available in a written document that is clear, understandable, and prominently displayed; 


b.      
orally provided when the service is scheduled or when the patient asks about costs; and 


c.       
available in accessible formats, and in the language(s) spoken by the patient. 


For example, if you expect to see your therapist for ongoing sessions throughout the year, the good faith estimate would be calculated by: 


·       
One weekly therapy session continuing through the end of the year, at $X (your agreed upon rate) per session for a total
of 50 weeks, accounting for vacations and holidays for an estimated total of [$X x 50]. 


·       
Should you be seen for individual therapy in addition to couples/family sessions with another therapist, a separate good
faith estimate would apply for the additional services and will be given to you by your provider that may be different than the good faith estimate agreed upon with your personal therapist 


·       
Should you request additional weekly sessions throughout the year totaling more than the estimated 50 sessions noted in
the good faith estimate, client may use the same formula to determine your total cost of services [$X x number of sessions conducted]. 


Is the good faith estimate binding? 


The information provided in the good faith estimate is only an estimate, and the actual items, services, or charges may differ from what is included in
the good faith estimate. However, uninsured or self-pay individuals may challenge a bill from a provider through a new patient-provider dispute resolution process if the billed charges substantially exceed the expected charges in the good faith estimate. Substantially
exceeds means an amount that is at least $400 more than the expected charges listed on the good faith estimate for a specific provider. 

* More information can be found at: 

https://www.apaservices.org/practice/legal/managed/billing-disclosure-requirements ​