Good Faith Estimate Notification

Insurance 

The No Surprises Act (NSA) was enacted in 2021 to protect consumers from receiving medical bills the consumers didn’t expect.  On January 1, 2022, a state-licensed or certified healthcare provider or facility must provide a Good Faith Estimate of the expected charges – to new patients and continuing patients – who either don’t have insurance or are not planning to submit a claim for payment to their insurance carrier. The No Surprise Act has specific rules for what information the estimate must provide and the timeline for providing the estimate. Healthcare providers must provide self-insured patients and self-pay patients of their “right” to receive the Good Faith Estimate.

 

A few key notes/disclaimers:

·         When services are required at least 10 business days in advance, the Good Faith Estimate must be given to the client within 3                          business days of the scheduling of the services – not the appointment date.

·         When a service is scheduled at least 3 days in advance, the Good Faith Estimate must be given to the client – within 1 business day of            scheduling.

·         When a service is scheduled less than 3 business days in advance, no Good Faith Estimate is required.

·         The provider has the right to recommend additional services or items (not part of the treatment), that are not reflected in the Good              Faith Estimate – provided these added items are scheduled separately.

·         The key word is “estimate.” There is an understanding that the services, charges, or items provided may change based on the                           treatment.

·         The client can pursue the PPDR dispute resolution process.

·         The receipt of the Good Faith Estimate does obligate the client to obtain the services listed on the estimate from the provider.

 

The Good Faith Estimate requirements do NOT apply if the client is using Medicare, Medicaid, or another federal healthcare program (such as TRICARE). A Good Faith Estimate is not required for emergency services – which, by definition, cannot be scheduled in advance.

For questions or more information about your right to a GFE, visit cms.gov/nosurprises or call 346-206-3992.

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