The ‘No Surprises Act’, is a federal consumer protection law that protects clients from receiving unexpected medical bills and helps control the practice knowns as “Surprise Billing” for medical care. The Good Faith Estimate (GFE) provision of the No Surprises Act gives patients an estimated cost (prior to their appointment) for the healthcare services that they will be receiving. The rule requires that providers and facilities provide a good faith estimate of the charges to the un-insured (or self-pay) individuals so they can know what costs to expect when seeking healthcare1.
Here are the key components of GFE:
GFE for Uninsured Patients
- As of January 1, 2022, state-licensed or certified health care providers need to give a Good Faith Estimate of healthcare charges to all clients who are either uninsured, self-pay or insured but do not plan to use their insurance benefits to pay for the health care services.
- A provider must provide a GFE to the uninsured individuals, including any item or service that is reasonably expected to be provided in conjunction with a scheduled or requested item or service by another provider or facility.
- A good faith estimate issued to an uninsured (or self-pay) individual under this section is considered part of the patient’s medical record and must be maintained in the same manner as a patient’s medical record.
- In the case if the clients are billed for more than the Good Faith Estimate, they have the right to dispute the bill.
GFE for Insured Patients
- A provider or facility must also give Good Faith Estimate when an individual requests it (regardless of whether they have scheduled the item or service)1.
- The Act applies to all healthcare providers and facilities operating under the scope of a state-issued license or certification. No specific specialties, types of service, or facilities are exempt.
- The Good Faith Estimate provisions do not apply if the client is a participant in Medicare, Medicaid, or other federal healthcare programs.
- Good Faith Estimates are also not generally required for emergency services, which by their nature cannot be scheduled in advance.
GFE for Facilities
- The good faith estimate will also include items or services reasonably expected to be provided along with the primary item(s) or service(s), even if the individual will receive the items and services from another provider or another facility.
- The good faith estimate will provide an itemized list of items and services, grouped by each provider or facility, that is reasonably expected to be provided as part of the primary item or service, and items and services reasonably expected to be furnished in conjunction with the primary item or service, for that period of care.
- A new patient-provider dispute resolution (PPDR) process will be available for uninsured (or self-pay) individuals who get a bill from a provider that is substantially in excess of the expected charges on the good faith estimate.