How do I do a Good Faith Estimate?

A good faith estimate (GFE) from the “No Surprises Act” started in 2021 and refers to an upfront estimate provided by a clinician to a client regarding the anticipated costs of care. This estimate aims to give clients transparency about the financial aspects of their care, helping them make informed decisions about their treatment options and understand their potential financial responsibility.

What’s your part in all of this? Here’s what to do:

1. Find out if your client is using insurance. If they are not using insurance, then proceed with the following steps. If they are using insurance, you don’t need to go any further.

2. Give them the Notice of Right to Receive a Good Faith Estimate (both verbally and in writing). You should also have it posted on your website. It can be provided as part of your intake paperwork but also needs to be reviewed verbally with your client. Verbal notice alone is considered non-compliant. The good faith estimate must be provided within three business days of scheduling.

3. Provide the GFE (here’s a sample one). Sometimes your electronic health record will have one that it auto-generates for your client. I use Ivypay and it gives me the option of sharing one with my clients. It should include:

   ● Name 

   ● Date of birth

   ● Description of the services that will be provided, in easy-to-understand language.

   ● A time range for expected services. This is especially important for therapists, as the service is rarely provided in one session.

   ● Diagnostic codes, service codes, and expected charges associated with each of those services

   ● Provider name, National Provider Indicator (NPI), and tax ID number

   ● Office location where services will be provided

   ● A disclaimer that states that the good faith estimate is only an estimate and that charges may be different from the estimate

   ● A disclaimer that informs the patient of their right to initiate a Patient-Provider Dispute Resolution (PDDR) process if the billed charges substantially exceed the expected charges in the good faith estimate.

   ● A disclaimer that the good faith estimate is not a contract and does not require the individual to obtain the services from any of the providers or facilities identified in the good faith estimate.

4. Keep a copy of the GFE. It must be made available upon request for at least six years after it is was given.

RESOURCES:

Curious to see a few good website examples? Here are some I found: example A and B.

Here’s a good FAQ from the ACA. And another one from Theraplatform.

Questions, comments, more?