Good Faith Estimate

1. January 1, 2022 the "No Surprises Act" was implemented.

2. What does it mean?

Providers are required to send all self-pay/out of network clients a Good Faith Estimate:

  • Good Faith Estimate (GFE)- this estimate must be provided to all clients who will be billed as private pay and/or if you are considered an out-of-network provider with their insurance company. This will also apply to anyone deciding to forgo using their insurance and chooses to be private pay instead.
  • The GFE must be provided by request if a patient is “shopping for care” and not yet ready to schedule. This must be provided within 3 business days after the date of the request.
  • The GFE must be provided before the scheduled service and must be provided orally, and as a written statement with specific information including pt’s name/DOB/ itemized list of services/applicable Dx/ provider’s information. CMS has published a template that I have attached. The GFE must also include specific disclaimers which are on the template. There are specific time frames in which the GFE must be provided. However, the only time the GFE will not be required is if the primary service is scheduled less than three days before the service is scheduled to be “furnished.”
  • One GFE may be provided for recurring services up to 12 months.
  • If the actual billed charges are more than $400 than the total amount of expected charges listed on the GFE, the client has the right to dispute.