Your right to understand the expected cost of care.

Your Right to a Good Faith Estimate

Under the federal No Surprises Act, healthcare providers generally must provide a Good Faith Estimate to people who are uninsured or who are choosing not to use their health insurance to pay for care.

Your estimate will identify the services that are reasonably expected based on the information available at the time the estimate is prepared and the expected charges for those services.

You may request a Good Faith Estimate before scheduling services or when you schedule care.

When You Will Receive Your Estimate

Federal rules establish the following timeframes:

• If you schedule services 3 to 9 business days in advance, your Good Faith Estimate generally must be provided within 1 business day after scheduling.
• If you schedule services 10 or more business days in advance, your Good Faith Estimate generally must be provided within 3 business days after scheduling.
• If you request an estimate before scheduling services, it generally must be provided within 3 business days of your request.

When services are scheduled only 0 to 2 business days in advance, federal law does not require a Good Faith Estimate to be provided before that appointment solely because the service was scheduled on short notice.

What Your Estimate Includes

Your Good Faith Estimate will include an itemized estimate of the charges for healthcare items or services that are reasonably expected as part of your care with the provider issuing the estimate.

The estimate is based on the information reasonably known at the time it is prepared. Your treatment needs may change, and services that were not reasonably anticipated when the estimate was created may not be included.

If your expected services or treatment plan changes substantially, an updated Good Faith Estimate may be appropriate.

A Good Faith Estimate Is Not a Bill

A Good Faith Estimate is an estimate of expected charges. It does not require you to receive the services listed in the estimate and does not obligate you to continue treatment for any particular period of time.

You remain free to discuss your treatment plan, frequency of appointments, costs, and other options with your clinician.

We also provide clients with written information regarding our fees and payment arrangements as part of the professional relationship.

If Your Bill Is Higher Than Your Estimate

Keep a copy of your Good Faith Estimate so you can compare it with any bills you receive.

If a bill from a provider is at least $400 more than the Good Faith Estimate provided by that provider, you may be eligible to use the federal Patient-Provider Dispute Resolution process.

In general, the dispute must be initiated within 120 calendar days of the date on the original bill.

You may also contact the provider directly to ask about the difference between the estimate and the amount billed.

For information about your federal rights or the dispute-resolution process, you can contact the No Surprises Help Desk at 1-800-985-3059 or visit the Centers for Medicare & Medicaid Services website.

Request a Good Faith Estimate

If you believe you are eligible for a Good Faith Estimate, you may request one from Austin Concierge Therapy before scheduling services or when arranging your care.

Please let us know that you are requesting a Good Faith Estimate and whether you:

• Do not have health insurance, or
• Have health insurance but do not plan to submit a claim to your health plan for the services you are requesting.

If you are unsure whether the Good Faith Estimate rules apply to you, contact our office and we can help you determine the appropriate next step.

Questions or Assistance

If you have questions about fees, your Good Faith Estimate, or how to request one, please contact Austin Concierge Therapy.

We want the financial side of care to be clear before you begin. If something about the expected cost of services is unclear, please ask us.