NO SURPRISES ACT of 2021
The law requiring Good Faith Estimates in healthcare comes from the No Surprises Act, a federal law passed as part of the Consolidated Appropriations Act, 2021. Summary of the Healthcare Good Faith Estimate Requirement. Even though therapy session fees are set and disclosed at the start of the therapy relationship, therapists were included in the regulation that requires healthcare facilits to provide a Good Faith Estimate (GFE).
1. Purpose:
To protect patients—especially those without insurance or who choose not to use it—from unexpected medical bills and surprise charges.
2. Who Must Comply:
Healthcare providers (e.g., doctors, clinics, hospitals)
Facilities (e.g., surgery centers, mental health centers)
3. Who It Protects:
Uninsured patients
Self-pay patients (those not using insurance)
4. What Must Be Provided:
A Good Faith Estimate (GFE) of expected charges for medical items or services before they are provided.
5. When It Must Be Provided:
Within 1–3 business days after scheduling a service or upon request.
Applies to non-emergency services.
6. What's Included in the Estimate:
Cost of the primary service
Likely additional services (labs, imaging, anesthesia, etc.)
Names of other providers involved
Expected charges itemized
Disclaimer about dispute rights
7. Patient Protections:
If the final bill is $400 or more above the GFE, patients can initiate a dispute resolution process through the U.S. Department of Health and Human Services (HHS).
Legal Authority:
No Surprises Act (2021)
Enforced by Centers for Medicare & Medicaid Services (CMS) under HHS.
In Short:
The healthcare Good Faith Estimate rule ensures that uninsured and self-pay patients receive upfront cost estimates for scheduled medical care, reducing surprise billing and improving price transparency.
GOOD FAITH ESTIMATE SAMPLE
This is an example of what a Good Faith Estimate will include. The rate used in the example may not be your current session fee. This example is for education purposes and is not your specific GFE.
Provider Information:
Provider Name: Jane Doe, LCSW
Practice Name: Pathways Counseling Center
NPI Number: 1234567890
Tax ID (TIN): 12-3456789
Phone: (123) 456-7890
Email: jane@pathwayscounseling.com
Office Address: 123 Wellness Way, Suite 101, City, State ZIP
Patient Information:
Name: John Smith
Date of Birth: 01/01/1990
Phone: (987) 654-3210
Email: john@example.com
Description of Services:
Service Code (CPT)
90837 (-95 if telehealth)
Description
60 Minute Individual Therapy
This estimate is for psychotherapy services provided by a licensed mental health professional for the treatment of a mental health condition.
Fee Per Unit
$180
Estimated Frequency
10 sessions
Estimated Total
$1800
Disclaimers (Required by Law):
“This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. This estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur.”
“If you are billed for more than $400 above this Good Faith Estimate, you have the right to dispute the bill.”
“You may contact the provider listed above to let them know the billed charges are higher than expected. You can also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). For questions or more information about your right to a Good Faith Estimate or how to start a dispute, visit: www.cms.gov/nosurprises”