Your Rights and Protections
Under the No Surprises Act
The No Surprises Act provides federal protections related to health care costs and unexpected medical bills. For clients of Positive By Design LLC who do not have health insurance or who choose not to use their health insurance to pay for psychotherapy, one important protection is the right to receive a Good Faith Estimate of expected charges.
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
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If you do not have health insurance, or if you have insurance but choose not to have a claim submitted to your health plan for your care, you generally have the right to receive a Good Faith Estimate of expected charges when you request one or when services are scheduled at least three business days in advance.
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A Good Faith Estimate is not a bill. It provides an estimate of the charges reasonably expected for your care based on the information available when the estimate is prepared.
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Because psychotherapy is individualized and its frequency and duration may change over time, your actual course of treatment may differ from what was initially anticipated. If the expected scope, frequency, or duration of services changes, your estimate may need to be updated.
When Will I Receive a Good Faith Estimate?
If you schedule services 3–9 business days in advance, you should receive a Good Faith Estimate within 1 business day after scheduling. If you schedule services 10 or more business days in advance, you should receive one within 3 business days after scheduling.
You may also request a Good Faith Estimate before scheduling services. In that situation, the estimate generally must be provided within 3 business days of your request. The federal requirement does not entitle you to an estimate when services are scheduled only 0–2 business days in advance.
If Your Bill Is Higher Than Your Estimate
If a bill from a provider is at least $400 more than the amount listed on that provider's Good Faith Estimate, you may be eligible to use the federal patient-provider dispute resolution process. A dispute generally must be initiated within 120 days of receiving the initial bill.
Keep a copy of your Good Faith Estimate so that you can compare it with your bill.
Additional Information
For additional information about Good Faith Estimates and your rights under the No Surprises Act, visit the Centers for Medicare & Medicaid Services (CMS) or call the No Surprises Help Desk at 1-800-985-3059.
In Missouri, additional information about consumer protections and assistance is available through the Missouri Department of Commerce and Insurance at 1-800-726-7390.