No Surprises Act and Good Faith Estimate
Under the No Surprises Act, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to be aware of any charges and to receive an estimate prior to receiving these services. You can ask for a Good Faith Estimate before you schedule a service, or at any time during treatment. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate (GFE), or how to dispute a bill, see your GFE document, or visit www.cms.gov/nosurprises.
The following document serves as notification of these rights and protections: https://www.cms.gov/files/document/standard-notice-consent-forms-nonparticipating-providers-emergency-facilities-regarding-consumer.pdf
Additionally, you have the right to receive a Good Faith Estimate (GFE) of the cost of services typically offered by your therapist over a 12-month period. As always, each client may decide how long they would like to participate in mental health care and we will collaborate with you on a regular basis to determine how many sessions you may need.
If you receive a bill for services that is at least $400 more than your Good Faith Estimate (GFE), you may file a dispute.
For questions or more information about your right to a Good Faith Estimate and this federal requirement, visit www.cms.gov/nosurprises.
Under the No Surprises Act, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to be aware of any charges and to receive an estimate prior to receiving these services. You can ask for a Good Faith Estimate before you schedule a service, or at any time during treatment.
Your Rights Under the No Surprises Act
You have the right to:
Receive a Good Faith Estimate of costs before receiving services
Be billed at in-network rates for emergency services, even from out-of-network providers
Choose your provider and be informed about their network status
Dispute unexpected bills that are significantly higher than your Good Faith Estimate
Not be charged for the difference between what your insurance pays and the provider charges (balance billing) in certain situations
What is a Good Faith Estimate?
A Good Faith Estimate is a written document that shows the expected costs for mental health services, including:
Therapy session fees
Diagnostic assessments (if applicable)
Any other services that may be provided as part of your treatment
The estimate is based on information known at the time it is created and may change based on your specific needs and treatment plan.
Who can request a Good Faith Estimate?
You have the right to request and receive a Good Faith Estimate if you:
Do not have health insurance, or
Have health insurance but choose not to use it (self-pay), or
Are seeking services that are not covered by your insurance
Even if you have insurance, you can always ask for a Good Faith Estimate to understand potential out-of-pocket costs.
At this time, Wildflower Walk Psychotherapy is not paneled with any insurance company, and all services are provided with self-pay. If this changes, you will be notified.
Before Scheduling
You may request a Good Faith Estimate before scheduling your first appointment. Contact me at:
Email:
After Scheduling
If you have already scheduled an appointment, I will provide your Good Faith Estimate in accordance with federal law requirements (typically at least 1 business day before your scheduled service, or at least 3 business days in advance for services scheduled more than 10 days in the future).
What to do with your estimate
Keep a copy of your Good Faith Estimate for your records
Review it carefully and ask questions if anything is unclear
Compare the estimate to your actual bill after receiving services
What if your bill is higher than expected?
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.
How to dispute a bill
Contact me first: Reach out to laumick@wildflowerwalkpsychotherapy.com or call to discuss the difference
Initiate a dispute: If we cannot resolve the issue, you can start a dispute resolution process
Timeline: You must initiate the dispute within 120 days of receiving the bill
Patient-Provider Dispute Resolution
For information about the federal dispute resolution process, visit:
Website: www.cms.gov/nosurprises
Phone: No Surprises Help Desk at (800) 985-3059
Protection from surprise billing
The No Surprises Act protects you from certain unexpected charges in emergency and non-emergency situations.
Emergency Services:
If you receive emergency mental health care, you can only be billed at in-network rates, even if:
The provider is out-of-network with your insurance
You receive care at an out-of-network facility
You did not have time to get prior authorization
Note: Wildflower Walk Psychotherapy provides scheduled teletherapy services only. I do not provide emergency services. If you are experiencing a mental health emergency, please call 988 (Suicide & Crisis Lifeline) or 911. A list of emergency services will be provided prior to the start of services and is available on this website.
Services at in-network facilities
If you receive services at an in-network facility from an out-of-network provider, you are protected from balance billing unless:
You were given written notice at least 72 hours in advance
You gave written consent to be billed by the out-of-network provider
Key Terms
Balance Billing:
When a provider bills you for the difference between what your insurance pays and the provider’s full charge.
Out-of-Network Provider:
A healthcare provider who does not have a contract with your health insurance plan.
In-Network Provider:
A healthcare provider who has a contract with your health insurance plan to provide services at negotiated rates.
Good Faith Estimate:
A written estimate of expected charges for scheduled healthcare services for uninsured or self-pay patients.
Questions or Concerns?
Contact Lindsey Aumick:
Contact the No Surprises Help Desk:
Website: www.cms.gov/nosurprises
For More Information:
For detailed information about your rights under the No Surprises Act, visit the Centers for Medicare & Medicaid Services (CMS) website at www.cms.gov/nosurprises.
