Good Faith Estimate
Under the No Surprises Act · Effective January 1, 2022
Under the law, health care providers need to give patients who don't have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate and the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.
How to request your Good Faith Estimate
If you are uninsured or choose not to use your insurance for counseling services, you are entitled to a written Good Faith Estimate before your first session. To request one, contact the Practice using any of the methods below. An estimate will be provided within the timeframes described above.
What the estimate includes
Your Good Faith Estimate will include:
- The services expected to be provided (for example, initial assessment and ongoing individual therapy sessions)
- The current self-pay rate per session ($150)
- An expected frequency and number of sessions, based on your initial conversation with Matt
- Relevant billing codes (CPT codes such as 90791, 90834, 90837)
- A primary diagnosis code, once a diagnosis has been established
- An expected total cost range
The estimate reflects expected costs at the time it is issued. If the scope of treatment changes substantially, a revised estimate will be provided.
If your bill exceeds the estimate
If you receive a bill that is at least $400 more than any item or service included in your Good Faith Estimate, you have the right to dispute the bill through the federal patient-provider dispute resolution process. Learn more at cms.gov/nosurprises.
If you are using insurance
The Good Faith Estimate requirement described above applies to uninsured and self-pay patients. If you are using insurance through the Practice's billing partner Headway, your costs are determined by your plan's benefits, deductible, copay, and coinsurance. Contact your insurance carrier or Headway for a benefits estimate.
Request or ask a question
Matt Mueller, LPC
302 Provines Dr, Austin, TX 78753
matt@theanxietyauthority.com — (737) 352-5698