GOOD FAITH ESTIMATE
Under Section 2799B-6 of the Public Health Service Act, as of 1/1/2022 health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.
Who qualifies as a self-pay patient?
A provider’s duty to provide notice and a GFE applies to self-pay clients, i.e., an individual who
does not have benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, federal healthcare program, or a health benefits plan; or
chooses not to use his or her coverage benefit for the item or service.
Individuals enrolled in short-term, limited-duration health plans or other types of products not regulated as health insurance coverage (e.g., health-sharing ministries) are considered self-pay clients.
If an individual’s plan or coverage provides no benefit for out-of-network services, the individual would be a self-pay client for any out-of-network provider. If, however, the plan or coverage provides a limited benefit (e.g., higher co-insurance items or services furnished by out-of-network providers), the individual would not be a self-pay client (unless the individual chose not to use such coverage benefit for the item or service).
If I am eligible for this estimate, when and how will I receive it?
You will receive this estimate prior to attending your first scheduled appointment if you are eligible as a self-pay client. All services and fees are clearly stated in our Informed Consent new client paperwork for you to review prior to your appointment. Your therapist will also discuss these fees with you prior to and during your initial appointment, and answer any questions you may have related to any applicable fees.