No Surprises Act
The No Surprise Act is a new federal rule that went into effect January 1, 2022, to protect consumers from surprise health care bills. Licensed Clinical Social Workers who provide psychotherapy and other health care provider types must provide a Good Faith Estimate (GFE) of expected charges that may be billed for items and services to individuals who are uninsured (e.g., not enrolled in any health plan or coverage) or who are self-pay (e.g., not seeking to file a claim with their plan or coverage). The GFE must be provided both orally and in writing, upon request or at the time of scheduling health care items and services.
Good Faith Estimate
Beginning January 1, 2022, if you’re uninsured or don’t plan to submit your claim to your health plan, healthcare providers and facilities must provide you with a GFE of expected charges before you get an item or service. The good faith estimate isn’t a bill.
Providers and facilities must give you a GFE if you ask for one, or when you schedule an item or service. It should include expected charges for the primary item or service you’re getting, and any other items or services provided as part of the same scheduled experience.
Note: You could be charged more than the estimate if you get additional items or services during your visit or procedure that your doctor didn’t anticipate.
What to expect from a GFE
Providers and facilities must give you:
Your GFE before an item or service is provided, within certain timeframes.
An itemized list with specific details and expected charges for items and services related to your care.
Your GFE in writing (paper or electronic). Note: A provider can discuss the information included in the estimate over the phone.
Your estimate in a way that’s accessible to you
If you are billed for $400 more than this Good Faith Estimate (GFE), you have the right to dispute the bill.
You may contact your provider directly to let them know the billed charges are at least $400 higher than the GFE. You can ask them to update the bill to match the GFE, 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 this GFE. 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 and get a form to start the process, go to:
www.cms.gov/nosurprises or call CMS at 1-800-985-3059
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For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059.