Beginning January 1, 2022, The “No Surprises Act” (the Act), a new federal mandate for those providing care to uninsured or self-pay clients are...

1. required to give uninsured and self-pay clients a good faith estimate of costs for services that they offer, when scheduling care or when the client requests an estimate: and
2. prohibited from balance billing “surprise bills” to clients for emergency and certain non-emergency services provided at facilities.

A Good Faith Estimate can be provided verbally but should also be given to the client as soon as possible as part of an informed consent or disclosure statement. 

• The patient’s name and date of birth;
• A description of the psychotherapy or other service(s) being furnished to the patient;
• An itemized list of items or services that are “reasonably expected” to be furnished;
• Expected charges associated with each psychotherapy session or other service(s);
• Your name, National Provider Identifier, Tax Identification Number, office location where services will be provided;
• A disclaimer that there may be additional items or services that you recommend as part of the treatment that will be scheduled separately and are not reflected in the good faith estimate;
• A disclaimer that the information provided in the good faith estimate is only an estimate and that actual items, services, or charges may differ from the good faith estimate; and
• A disclaimer that the good faith estimate does not require the private pay patient to obtain psychotherapy or other services from you.

• Summary of the key requirements along with links to templates provided by the American Psychiatric Association (APA)
• Standard Notice: “Right to Receive a Good Faith Estimate of Expected Charges” Under the No Surprises Act
• Standard Form: “Good Faith Estimate for Health Care Items and Services” Under the No Surprises Act