Good Faith Estimate

Good Faith Estimate

Effective January 1, 2022, a ruling went into effect called the “No Suprises Act”, which requires practitioners to provide a “Good Faith Estimate” (GFE) to individuals who are uninsured or utilize self- pay for services.

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. You could be charged more if complications or special circumstances occur and you will be provided with a new GFE should this occur. If this happens, federal law allows you to dispute (appeal) the bill if you and your provider have not previously talked about the change and you have not been given an updated GFE.

Under Section 2799B-6 of the Public Health Service Act (PHSA), health care providers and health care facilities are required to inform individuals who are not enrolled in a medical plan or have coverage or eligible for 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.

Note: The PHSA and GFE do not currently apply to any individuals who are using insurance benefits, including “out of network benefits” (i.e.., submitting superbills to insurance for reimbursement).

Timeline requirements: Providers are required to provide a GFE of expected charges for a scheduled or requested service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service. That estimate must be provided within specified timeframes:

  • If the service is scheduled at least 3 business days before the appointment date: no later than 1 business day after the date of scheduling;
  • If the service is scheduled at least 10 business days before the appointment date: no later than 3 business days after the date of scheduling; or
  • If the uninsured or self-pay individual requests a GFE (without scheduling the service), no later than 3 business days after the date of the request. A new GFE must be provided, within the specified timeframes if the individual reschedules the requested item or service.

Below are common services and diagnosis codes used at HEAL CCC; however, the lists are not exhaustive. With that said, codes can change based on many factors. Please speak to your provider with any questions or concerns.

Common Services at HEAL Center for Counseling and Complementary Health, LLC 

  • 90791: Initial Psychotherapy intake ($160)
  • 90832: Psychotherapy, 16-37 min ($75)
  • 90834: Ongoing therapy appointments, 38-52 min ($105)
  • 90837: Ongoing therapy appointments, 53-60 min ($155)
  • 90853: Group Psychotherapy (approx. 60 minutes) ($50-60)

Common Diagnosis Codes at HEAL Center for Counseling and Complementary Health, LLC 

  • Adjustment Disorder (F43.23)
  • Mental Disorder, Not Otherwise Specified (F99)
  • Depression (F32.9)
  • Generalized Anxiety Disorder (F41.1)
  • Obsessive Compulsive Disorder (F42.2)
  • Post-traumatic Stress Disorder (F43.10)

HEAL CCC recognizes every individual’s mental health treatment journey is unique and personalized. How long you need to engage in mental health services and how often you attend sessions will be influenced by many factors, including, but not limited to:

  • Your schedule and life circumstances
  • Your provider’s availability
  • Ongoing life challenges
  • The nature of your specific challenges and how you address them
  • Personal finances

You and your provider will continually assess the appropriate frequency of services and will work together to determine when you have met your goals and are ready for discharge and/or a new “Good Faith Estimate” will be issued should your frequency or needs change.

If you think you have been wrongly billed or are uncertain whether the No Surprises Act applies to you or if you have any additional questions about standard notice forms or the No Surprises Act in general, reach out to HEAL Center for Counseling and Complementary Health, LLC at 540-227-0018, office@healccc.com.

Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your rights to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-877-696-6775.