Anxiety Treatment Center of Orlando-Office of Jenifer Garrido, LCSW
Understanding The No Surprises Act of 2021 & The Good Faith Estimate
Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.
How Does This Relate to Receiving Mental Health Care?
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are CHOOSING not to use their health insurance, will be provided with a formal estimate of the expected charges for medical services, including psychotherapy services, referred to as a Good Faith Estimate, herein referred to as a GFE. You have the right to receive a GFE for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your GFE, 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, visit www.cms.gov/nosurprises. or call 1-800-MEDICARE (1-800-633-4227).
A Note Regarding “The No Surprises Act” from Practice Owner, Jenifer Garrido, LCSW
This law was enacted to protect consumers. By providing each client with a formal copy of their anticipated charges via the “The Good Faith Estimate”, what will be referred to as the “GFE”, they can knowingly choose a clinician that is right for them & begin therapy with an accurate understanding of the anticipated cost of these services.
As stated on my “Fees Page” on my website – https://anxietytreatmentorlando.com/fees/
I am SOLELY a Private Pay Practitioner. this means:
- I am NOT Contracted as an In-Network Provider with Any Insurance Companies. As such, I cannot provide you with any information regarding your in-network benefits or potential reimbursement from your insurance plan.
- -I encourage prospective clients to inquire with their insurance company regarding any & all financial questions & concerns, including their ability to submit claims for potential reimbursement, should they be interested in doing so. In fact, you can find a page on my website, entitled “Questions for Your Insurance Company” which may be of assistance. It is available by using the following link below: https://anxietytreatmentorlando.com/questions-for-your-insurance-company/
- Bottom Line – I believe that the most successful & effective therapy begins with honesty & trust, which is why I support the No Surprises Act & provide all new clients with a GFE. Legally, you always have the option of choosing a provider within your insurance’s network & it is important that you know your choices. I want potential clients to treat The Good Faith Estimate as their expected cost of treatment within my practice. My clients have access to their GFE, signed by BOTH of us, via my practice’s HIPAA-compliant, secure portal. I welcome any & all questions that you may have regarding The GFE, my fees or any other aspect of my practice. Please feel free to contact me via email or phone. Thank you.
Jenifer Garrido, MSW, LCSW
FL Lic No. SW5179
Anxiety Treatment Center of Orlando
719 Peachtree Rd, Ste 200
Orlando, FL 32804
Email – email@example.com
Practice Website – https://anxietytreatmentorlando.com/
Tax ID 593324198
Good Faith Estimate Defined*
A good faith estimate is a notification of expected charges for a scheduled or requested item or service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service.[vii] The expected charge for an item or service is the cash pay rate or rate established by a provider for an uninsured or self-pay patient, reflecting any discounts for those individuals.[viii]
Providers and health care facilities must furnish a good faith estimate of expected items or services on or after January 1, 2022, which will allow uninsured or self-pay individuals to have access to information about health care pricing before receiving care. The purpose of the good faith estimate requirement is to give individuals an opportunity to use the information to evaluate their health care options, manage care costs, and prevent surprise billing.
Good Faith Estimate Content Requirements
The good faith estimate provided by the convening provider or facility ix must contain the following information:
- -Patient name and date of birth
- -Description of the primary item or service in clear and understandable language as well as the date of service, if applicable (e.g., 50-minute individual psychotherapy session; DOS)
- Itemized list of items or services (e.g., 50-minute individual psychotherapy session, weekly until otherwise indicated)
- Applicable diagnosis codes, expected service codes, and expected charges associated with each listed item or service[x] (Note: Providers may have diagnoses for existing patients; however, prospective/new patients may not yet have a diagnosis and thus, this information may not be available. The provider should reasonably attempt to include expected service codes and expected charges associated with the service.)
- Name, National Provider Identifier (NPI), and Tax Identification Number (TIN) of each provider/facility represented in the good faith estimate[xi] and the states and office or facility locations where the items or services are expected to be furnished.
- Disclaimers regarding additional items or services that are recommended that must be scheduled or requested separately, that the good faith estimate is only an estimate and that actual charges may differ, that the patient has the right to initiate the patient-provider dispute resolution process if the actual bill charges substantially exceed the expected charges in the good faith estimate, and that the good faith estimate is not a contract and does not obligate the patient to obtain the items or services from any of the providers identified in the good faith estimate.[xii]
Note: If any information provided in the estimate changes (i.e., a provider raises fees or the agreement for the frequency or type of services changes), a new good faith estimate must be provided no later than one business day before the scheduled care. Also, if there is a change in the expected provider less than one business day before the scheduled care, the replacement provider must accept the good faith estimate as the expected charges.