Are you a psychiatrist treating uninsured or self-pay patients? If so, you are now required to provide a good faith estimate (GFE) of costs of your services to such patients. Pursuant to the No Surprises Act, healthcare providers must reveal an estimate of expected charges for a certain service or an item before furnishing it to a patient without an insurance coverage. Services related to mental health and substance use disorders are strongly emphasized in this new legislation that came into effect on January 1, 2022.
With that in mind, a GFE must be provided to the following patients receiving mental health treatment:
• Individuals who do not have any health insurance coverage (i.e., commercial policies, HMOs, union health plans or government health plans.)
• Individuals who do have an active insurance coverage, but refuse to utilize it to cover a certain service rendered to them
• Individuals who are shopping for care
A GFE must be based on one of the following factors:
• a unique cash pay rate or rate established by a provider for an uninsured (or self-pay) patient
• the amount the provider would expect to charge if the provider intended to bill a health care plan directly for such service
It is noteworthy that a good faith estimate is not legally binding to healthcare providers. Overestimations and underestimations are permitted. However, uninsured or self-pay individuals may appeal a bill from a provider through a new patient-provider dispute resolution process if the final billed charges substantially exceed the expected charges in the good faith estimate.
