No Surprise Act/Good Faith Estimates

As of January 1, 2022, if you self-pay for healthcare bills without submitting claims to insurance or are uninsured, healthcare providers and facilities must provide an estimate of charges that you may expect prior to receiving a service or item. This “good faith estimate” must be provided to you after you schedule an appointment for a service or item and/or upon your request. This estimate should include an estimate of charges expected for the primary service or item as well as any service or item that may be provided as part of the same scheduled appointment, and a list of any services and items.

The estimate is not required to include services and items provided to you by another healthcare provider or facility (also referred to as a co-provider or co-facility). However, in 2023, co-provider or co-facility cost information will be required to be provided by the provider or facility you contact.

What Does This Mean?

An example of how this may affect you would be if you are scheduled to have an operation, your good faith estimate may include the cost of surgery, as well as lab tests and anesthesia used during surgery. You may also require pre-surgery appointments or follow-up treatment. These services and items involved may not be included in the good faith estimate for the surgery.

If you are seeking mental health services as an uninsured person or are opting to self-pay without submitting claims to your insurance provider, you have the right to request a Good Faith Estimate.

What Must Healthcare Providers & Facilities Provide:

  • A good faith estimate prior to a service or item takes place, within certain timeframes that is accessible to you

  • An itemized list of the services or items that are grouped by the healthcare provider or facility offering the care and include details specific to the code associated with the care and estimated charge

  • If requested, an explanation of the good faith estimate to you either in person or over the phone, as well as a follow-up written estimate (electronic or paper)

What to do with a Good Faith Estimate

If you receive a good faith estimate, keep it in a secure spot. You may want to use it to compare future bills.

What does a Good Faith Estimate Look Like?

View a good faith estimate example here, courtesy of the Centers for Medicare & Medicaid.

What Happens if the Bill is More than the Good Faith Estimate?

If you receive a bill for a service or item that is $400 or more above the good faith estimate you received for that service or item, you might be eligible to begin the patient-provider dispute resolution process. This process is explained in detail here. 

Insurance ID Cards

New pricing details will be provided on any electronic or physical insurance plan or insurance identification (ID) card provided, beginning in 2022. This information will include a phone number and website where more information can be found, applicable deductibles, and out-of-pocket limits..

Your insurance provider may offer more information on their website, which you may find on your ID card, a link on a digital ID card, or a Quick Response (QR) code