Your right to a Good Faith Estimate

Money is one of the most common worries people carry into the decision to start therapy. If you are paying on your own, you deserve to know what to expect before you begin. Federal law protects that right.

Your right to receive a Good Faith Estimate of expected charges

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided. This includes therapy.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate and the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

Who can receive a Good Faith Estimate?

You can receive a Good Faith Estimate if you are uninsured, or if you have insurance but are choosing not to use it for these services (often called self-pay). This includes people who are not enrolled in a health plan, health insurance coverage or a federal health care program such as Medicare or Medicaid, and people who have coverage but do not plan to submit a claim.

How do I ask for one?

To ask for a Good Faith Estimate, use our request form and mention “Good Faith Estimate” in your message. You do not need to share health details to ask.

How does an estimate work for ongoing therapy?

Therapy usually happens over a series of sessions, so a Good Faith Estimate for recurring services describes the expected scope: how often sessions are expected, over what timeframe and how many in total. An estimate for recurring services cannot cover more than 12 months. If care continues beyond that, you will receive a new estimate. You will also receive an updated estimate if the expected services or charges change.

A Good Faith Estimate is not a contract, and it does not require you to receive the services listed. It is a tool to help you plan. Estimates are kept as part of your record, and you can ask for a copy of any estimate issued to you in the past six years.

What if my bill is higher than my estimate?

If your total bill from a provider is at least $400 more than that provider’s Good Faith Estimate, you may be able to use the federal patient-provider dispute resolution process. You must start the process within 120 calendar days of receiving the initial bill. An independent dispute resolution entity reviews the estimate and the bill and decides what amount you should pay. There is a small administrative fee to start a dispute.

Starting the dispute process will not adversely affect the quality of the care you receive. If your bill is higher than the estimate but by less than $400, you can still ask your provider to update the bill to match the estimate, talk about a payment plan or ask about financial options.

Where can I get help?

For questions about your rights, or to start a dispute, contact the federal No Surprises Help Desk:

• Phone: 1-800-985-3059
• Website: www.cms.gov/nosurprises
• Email: FederalPPDRQuestions@cms.hhs.gov

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