No Surprises Act & Good Faith Estimates
Under federal law, you have the right to receive a written estimate of expected costs before receiving care. This page explains your rights and what to expect from A Path to Wellness.
What is the No Surprises Act?
The No Surprises Act is a federal law that took effect on January 1, 2022. It was enacted to protect patients from unexpected medical bills. As part of this law, all healthcare providers, including mental health therapists, are required to provide written cost estimates to clients who are uninsured or who choose not to use their health insurance when paying for services.
If you are uninsured or if you are paying for services out-of-pocket without using your insurance benefits, you have the right to receive a Good Faith Estimate of expected charges before your care begins.
What is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written document that provides you with the expected costs of your healthcare services before you begin receiving care. It is provided to you free of charge and must be given to you before you start treatment.
A Good Faith Estimate is not a contract. It is not a guarantee that the final cost of your care will match the estimate. However, if your actual charges exceed the estimate by $400 or more, you have the right to dispute the bill. See the dispute resolution section below for details.
You are entitled to a Good Faith Estimate if you are uninsured, or if you have insurance but have chosen not to use it for the services you are receiving at A Path to Wellness. Clients using their insurance benefits are not covered under this provision.
What Your Good Faith Estimate Will Include
Under federal law, your Good Faith Estimate must include the following information at a minimum:
- Expected charges for each item or service anticipated during your treatment
- Itemized list of all items and services associated with your care that are reasonably expected to be provided
- Diagnosis codes and service codes (CPT codes) that correspond to the services being provided
- Provider information including name, National Provider Identifier (NPI), and Tax Identification Number (TIN) for each provider whose services are included
- Facility information including name, NPI, and TIN for each facility where services will be provided, if applicable
- Expected number of visits or sessions anticipated over the course of treatment
- Total estimated cost for all anticipated items and services
When You Will Receive Your Good Faith Estimate
The timeframe for receiving your Good Faith Estimate depends on when your appointment is scheduled and whether you are requesting an estimate without scheduling.
| Situation | When You Will Receive Your GFE |
|---|---|
| Appointment scheduled at least 3 business days in advance | No later than 1 business day before the appointment |
| Appointment scheduled at least 10 business days in advance | No later than 3 business days before the appointment |
| GFE requested without scheduling an appointment | Within 3 business days of the request |
If your appointment is scheduled with fewer than 3 business days' notice, a Good Faith Estimate will be provided as soon as reasonably possible prior to your appointment.
What the Good Faith Estimate Does Not Include
A Good Faith Estimate reflects the expected costs of services that are reasonably anticipated at the time it is created. It does not account for every possible situation. Specifically, a Good Faith Estimate:
- Is not a contract and does not obligate either party to provide or receive services at the estimated price
- Does not account for changes in your treatment needs that may arise during the course of care
- Does not include costs for services provided by other providers or facilities not named in the estimate
- Does not apply to services covered by your health insurance plan
- Is based on information available at the time of the estimate and is subject to change if your diagnosis or treatment plan changes significantly
If Your Bill Is Higher Than Your Good Faith Estimate
If you receive a bill that is $400 or more above the amount stated in your Good Faith Estimate, you have the right to dispute the bill through the federal Patient-Provider Dispute Resolution (PPDR) process. This is a right protected under the No Surprises Act and cannot be waived.
- Review your bill against the Good Faith Estimate you received. If the difference is $400 or more for the same item or service, you are eligible to initiate a dispute.
- Initiate the dispute within 120 calendar days of receiving your bill. Disputes submitted after this deadline may not be accepted.
- Submit your dispute through the federal dispute resolution portal managed by the Centers for Medicare and Medicaid Services (CMS). You will need your Good Faith Estimate, your itemized bill, and basic identifying information.
- An independent third party certified by the federal government will review your dispute. A Path to Wellness cannot influence or interfere with this process.
- Pay a small administrative fee to initiate the process. This fee may be refunded if the dispute is resolved in your favor.
A Path to Wellness cannot require you to waive your right to dispute a bill under the No Surprises Act. If you believe you have received a bill that exceeds your Good Faith Estimate by $400 or more, contact us and we will provide any documentation you need to support your dispute.
How to Request a Good Faith Estimate
You may request a Good Faith Estimate at any time before your first appointment, or at any point during your treatment. Requests can be made by phone or email. We will provide your estimate within the timeframes required by law.
If you have questions about your estimate, your bill, or your rights under the No Surprises Act, contact us directly and we will address them promptly.
A Path to Wellness
612 North Greene Street
Greensboro, NC 27401
Monday through Friday
9:00 AM to 5:00 PM EST
Additional Federal Resources
For more information about your rights under the No Surprises Act, including how to initiate a dispute, visit the official federal resources below.
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