Your Right to a Good Faith Estimate

Under the federal No Surprises Act, health care providers generally must give an uninsured or self-pay person a written Good Faith Estimate of expected charges when care is requested or scheduled within the timeframes below. A Good Faith Estimate is not a bill, does not require you to receive care, and does not guarantee the exact final cost.

Who is eligible

You are generally entitled to a Good Faith Estimate when you do not have health insurance for the service or when you have insurance but do not intend to have a claim submitted for the service. Tell the practice when scheduling if you will not be using insurance.

Kyle W McEvoy MH Counseling PC is an out-of-network practice. Out-of-network status, by itself, is not what creates this federal estimate right: the key question is whether you are uninsured or will not use insurance for the service. If you plan to submit a claim or have the practice submit one, ask your health plan about benefits, deductibles, authorization requirements, allowed amounts, and your expected out-of-pocket cost. Reimbursement is determined by your plan and is not guaranteed by the practice.

The Good Faith Estimate and patient-provider dispute provisions described here generally do not apply to services paid through Medicare, Medicaid, TRICARE, Veterans Affairs Health Care, or Indian Health Service programs, which have separate protections. Current federal guidance controls if it differs from this summary.

When the estimate is due

Under current federal guidance:

• If care is scheduled 3 to 9 business days in advance, the estimate generally must be provided within 1 business dayafter scheduling.
• If care is scheduled 10 or more business days in advance, the estimate generally must be provided within 3 business daysafter scheduling.
• If you request an estimate before scheduling, it generally must be provided within 3 business days after the request.

The federal rule does not require an estimate for care scheduled only 0 to 2 business days in advance, although you may still ask for cost information. The practice does not provide emergency care.

What a Good Faith Estimate includes

A Good Faith Estimate is provided in writing, on paper or electronically according to your requested delivery method. It identifies the provider and lists the items or services reasonably expected for the period of care, together with the expected charge for each item or service and other information required by federal rules.

Currently, a Good Faith Estimate generally lists expected charges for one provider or facility. If another clinician, laboratory, facility, pharmacy, or professional may provide a separate service, ask that provider or facility for its own estimate. Unanticipated services or changes in the course of care may not appear on the original estimate.

Recurring psychotherapy services

When periodic counseling or psychotherapy is reasonably expected, one Good Faith Estimate may cover recurring services rather than a separate estimate for every session. It should state the expected timeframe, frequency, and total number of recurring services. The estimated recurring period may not exceed 12 months. If care is expected to continue beyond that period, a new estimate must be provided.

Psychotherapy can change in frequency, duration, or scope as clinical needs develop. A Good Faith Estimate reflects what is reasonably expected when it is prepared; it is not a treatment recommendation or a promise that every listed service will occur. Ask for an updated estimate if the expected scope or charges materially change.

If a bill is at least $400 higher

If the bill from a provider or facility is at least $400 more than that provider's or facility's Good Faith Estimate, you may be eligible for the federal patient-provider dispute resolution process. You generally must start the dispute within 120 calendar days of the date on the initial bill and provide copies of the estimate and bill. The current process requires a $25 non-refundable administrative fee.

While an eligible dispute is pending, the provider or facility may not move the disputed bill into collections, threaten collections, collect existing late fees, or retaliate because you initiated the process. You and the provider may still agree on a payment amount before the independent reviewer decides the dispute.

Request an estimate or ask a question

You do not need to use special wording to ask for an estimate. Email kyle@kylewmcevoy.com or use the inquiry page, state that you are requesting a Good Faith Estimate, and indicate whether you prefer paper or electronic delivery. Do not include diagnoses, treatment records, or other clinical details in ordinary email.

For the federal consumer notice, timing rules, and examples, visit the Centers for Medicare & Medicaid Services. You may also submit a complaint to CMS if you believe a required estimate was not provided. Federal guidance and regulations control over any inconsistent statement on this page.