Beginning January 1, 2022, if you’re
uninsured or you pay for health care bills
yourself (don’t have your claims submitted
to your health plan), health care
providers and facilities must provide you
with an estimate of expected charges
before you get an item or service. This is
called a “good faith estimate.” Providers
and facilities must provide you with a
good faith estimate if you request one, or
after you’ve scheduled an item or service.
It should include expected charges for the
primary item or service you’re getting,
and any other items or services that are
provided as part of the same scheduled
experience.
The provider or facility you contact for a
good faith estimate must provide a list of
all items and services associated with
your care. In 2022, the estimate isn’t
required to include items and services
provided to you by another provider or
facility, but you can also ask these
providers or facilities for a separate
good faith estimate. In 2023, the provider
or facility you contact will be required
to provide co-provider or co-facility cost
information.
For example, if you’re
getting surgery, the good faith estimate
could include the cost of the surgery, any
lab services or tests, and the anesthesia
used during the operation. But, in some
instances, items or services related to
the surgery that are scheduled separately,
like pre-surgery appointments or physical
therapy in the weeks after the surgery,
might not be included in the good faith
estimate.
Providers and facilities must:
-Provide the good faith estimate before an
item or service is scheduled, within
certain timeframes.
-Offer an itemized list of each item or
service, grouped by the provider or
facility offering care. Each item or
service has to have specific details, like
the health care code assigned to it and
the expected charge.
-Explain the good faith estimate to you
over the phone or in-person if you request
it, and then follow up with a written
(paper or electronic) estimate.
-Provide the good faith estimate in a way
that’s accessible to you.
As it pertains to therapy, all this means
is that you will be informed of your
self-pay per session rate and the
cancellation fee.