Good Faith Estimates & The No Surprises Act
When you pay for healthcare out of pocket, generally, health care providers and facilities must give you an estimate of expected charges when you schedule an appointment for a health care item or service, or if you ask for an estimate.
This is called a “good faith estimate.” A good faith estimate isn’t a bill.
The good faith estimate shows the list of expected charges for items or services. Because the good faith estimate is based on information known at the time we create the estimate, it won’t include any unknown or unexpected costs that may be added during your treatment. If you add services at any time you will be made fully aware of the cost in advance.
Generally, the good faith estimate must include expected charges for:
- The primary item or service
- Any other items or services you’re reasonably expected to get as part of the primary item or service for that period of care.
Your right to a good faith estimate
Providers and facilities must give you the good faith estimate:
- After you schedule a health care item or service.
- If you schedule an item or service at least 3 business days before the date you’ll get the item or service, we must give you a good faith estimate no later than 1 business day after scheduling. If you schedule the item or service OR ask for cost information about it at least 10 business days before the date you get the item or service, we must give you a good faith estimate no later than 3 business days after you schedule or ask for the estimate.
- That includes a list of each item or service with the provider, and specific details, like the health care service code.
- The estimate is given in a way that’s accessible to you
- We must also explain the good faith estimate to you over the phone or in person if you ask, then follow up with a written (paper or electronic) estimate.
We provide all clients with good faith estimates as part of their initial paperwork. Keep the estimate in a safe place so you can compare it to any bills you get later. After you get a bill for the items or services, if the billed amount is $400 or more above the good faith estimate, you may be eligible to dispute the bill.
Good faith estimates do not apply to life coaching or biblical counseling as they are not medical services.