Banner photo by Ruben Hopwood

Right to a Good Faith Estimate of Costs for Services

Patients have the right since January 2022 to be protected from excessive billing costs or surprise (unexpected) bills for healthcare items and services.

Patients who do not have insurance or who choose not to use insurance and do not seek reimbursement from insurance (those who self-pay) have a right to request and receive an estimate of the total expected (estimated) costs for non-emergency items and services prior to scheduling an item or service.

Estimates will be provided in writing and orally when a service is scheduled, changed, or in response to a patient request.

Check this page for detailed information on your rights under the law.

All services provided by Hopwood Counseling & Consulting, LLC and by Life Cycles Therapy are considered out-of-network (OON). This means that neither of these providers have an agreement with any health insurance plan to provide any services to members of those plans. Costs for OON services may be higher than costs for equivalent in-network care.

See our practice fees and billing codes for our services here.

Patients are advised to keep copies of any estimates to compare to bills.

Insurance

Insurance plans may not cover any or may cover only a portion of the entire cost for out-of-network (OON) services. Patients are encouraged to see the Fees page for more information to assist when checking their own plan benefits and before scheduling services with Hopwood Counseling & Consulting, LLC or with Life Cycles Therapy.

All patients will be sent an estimate whether or not they meet the definition* of who must receive a Good Faith Estimate under the law. Patient’s rights and benefits under the law are specific to uninsured and self-pay individuals.

*Note: Individuals who submit claims for reimbursement of OON fees are not included in the No Surprises Act. They do not meet the requirement for a Good Faith Estimate since their insurance plan will define the costs and limits for items or services they use and for which they are reimbursed.

No Surprises Act

As of January 1, 2022, physicians, psychologists, social workers, and most health care providers are required by law to give uninsured and self-pay patients, who are not seeking insurance reimbursement for OON items and services, a Good Faith Estimate (GFE) of costs for items and services both orally and in writing upon request before providing non-emergency services or items. The estimate must include expected charges for the primary service or items, the scope of services (timeframe, frequency, total number, etc.), and any reasonably expected additional services or items. GFE’s expire in 12 months or if services or costs change. (Recurring services such as ongoing therapy will include information on expected number sessions and total cost for one year.)

A GFE is not a contract and an individual is not obligated to start or continue services with any provider or facility listed on the GFE.

The regulations on GFEs put into action part of the No Surprises Act, passed in December 2020 that protects patients from surprise bills by requiring health care providers to inform patients of expected charges for out-of-network services or items prior to providing those services or items.

Individuals who are uninsured or self-pay for care and do not seek reimbursement for OON benefits from their insurer, in most cases, are included in these protections. The specific section of the No Surprises Act that covers GFEs for self-paying patients is Part E of title XXVII of the Public Health Service (PHS) Act, section 2799B-6(2)(B) and the interim final rules at 45 CFR 149.610.

Who & What is included?

The category “provider” means any licensed or certified health care professional who is acting within the scope of their license or certification and according to the relevant laws of the location where they are licensed or certified.

The regulation covers all “items and services” provided by a health care professional, defined in part as visits (encounters), procedures, tests, substance use treatment, prescription drugs, equipment, and other types of health care items and services.

More info

Questions? Visit https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills

Still have questions? Uninsured and self-pay consumers not seeking insurance reimbursement for OON benefits may visit CMS.gov/nosurprises, or call the Help Desk at 1-800-985-3059, 8am-8pm ET seven days a week for more information. TTY users can call 1-800-985-3059.