Good Faith Estimate

What Is a Good Faith Estimate?

A Good Faith Estimate (GFE) provides an estimate of the expected charges for healthcare services you may receive. It is intended to help you understand the anticipated cost of care before services are provided.

A Good Faith Estimate is not a bill. It reflects the expected costs based on information available at the time the estimate is prepared. Because treatment needs may change, the estimate may not include unknown or unexpected services that are recommended or requested later during treatment.

What May Be Included in a Good Faith Estimate?

A Good Faith Estimate may include:

• The primary service you are scheduled to receive.
• Other services that are reasonably expected to occur as part of your planned course of care.
• Applicable service descriptions and billing codes when required.

For example, if you schedule individual psychotherapy, your Good Faith Estimate may include the anticipated cost of your scheduled therapy sessions and services that are reasonably expected as part of your treatment plan.

Some services may require a separate Good Faith Estimate if they are requested or scheduled after your initial estimate. Examples may include:

• Diagnostic evaluations
• Interactive complexity services
• Additional psychotherapy services
• Crisis psychotherapy
• Clinical documentation or reports
• Complex care coordination
• Other services requiring additional professional time

Your Right to Receive a Good Faith Estimate

Under the federal No Surprises Act, uninsured and self-pay clients have the right to receive a Good Faith Estimate explaining the expected cost of scheduled healthcare services.

HEAL CCC will provide a Good Faith Estimate:

• When you schedule services as a self-pay client.
• When you request an estimate of expected costs before receiving services.
• Within the required timeframe based on when services are scheduled or when an estimate is
  requested.

Good Faith Estimates will include information about expected services, applicable providers, and anticipated charges.

Reviewing Your Estimate

Please keep your Good Faith Estimate in a safe place so you can compare it with future billing statements.

If the amount you are billed is substantially higher than your Good Faith Estimate, you may have the right to dispute the bill through the federal dispute resolution process.

Generally, individuals may be eligible to dispute charges when the billed amount is $400 or more above the estimated amount for the same service.

Insurance and Good Faith Estimates

If you are using health insurance, your final responsibility may vary depending on your insurance plan, deductible, copayment, coinsurance, authorization requirements, and coverage determinations.

Insurance benefits are determined by your insurance carrier. A Good Faith Estimate does not replace an insurance benefit verification or guarantee payment from your insurance company.

Questions or More Information

If you have questions about your Good Faith Estimate, expected costs, or your rights under the No Surprises Act, please contact HEAL CCC. Additional information about the No Surprises Act is available through the Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov/nosurprises

You may also contact CMS at: 1-800-MEDICARE (1-800-633-4227)