Good Faith Estimate

General Information on Good Faith Estimate: 

This Act Applies to Self-Pay Clients that are uninsured or are not using a superbill for their out-of-network benefits. These clients will be provided a GFE prior to onset of services.

Good Faith Estimate Effective January 1, 2022, a ruling went into effect called the "No Surprises Act" which requires practitioners to provider a "Good Faith Estimate" about out-of-network care. The Good Faith Estimate works to show the cost of items and services that are reasonably expected for your health care needs for an item or service, a diagnosis, and a reason for therapy. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur and will be provided a new "Good Faith Estimate" should this occur. If this happens, federal law allows you to dispute (appeal) the bill if you and your therapist have not previously talked about the change and you have not been given an updated good faith estimate. 

Under Section 2799B-6 of the Public Health Service Act (PHSA), health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request, or at the time of scheduling health care items and services to receive a "Good Faith Estimate" of expected charges.  

Note: The PHSA and GFE does not currently apply to any clients who are using insurance benefits, including "out of network benefits" (i.e.., submitting superbills to insurance for reimbursement).  

Timeline requirements:

Practitioners are required to provide a good faith estimate of expected charges for a scheduled or requested service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service.” That estimate must be provided within specified time frames:  

  • If the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling;  

  • If the service is scheduled at least 10 business days before the appointment date, no later than three business days after the date of scheduling; or  

  • If the uninsured or self-pay patient requests a good faith estimate (without scheduling the service), no later than three business days after the date of the request. A new good faith estimate must be provided, within the specified timeframes if the patient reschedules the requested item or service. 

Where Services Will be Delivered: 

In-person at PFC address (listed below) or via telehealth. 

Pathways Family Counseling Location: 

6785 Wallings Road, North Royalton, Ohio 44133 

Common Services/Billing Codes: 

  • 90791: Initial therapy intake  

  • 90837: Ongoing therapy appointments  

  • 90847: Family/Couples appointments  

  • 90785: Interactive Complexity Add-On 

Common Diagnosis Codes: 

  • Adjustment Disorder (F43.23) 

  • Depression (F32.9)  

  • Anxiety (F41.1) 

  • Bipolar (F31.9) 

  • PTSD/Post Traumatic Stress Disorder (F43.10) 

Pathways Family Counseling recognizes every client's therapy journey is unique. 

How long you need to engage in therapy and how often you attend sessions will be influenced by many factors including: 

  • Your schedule and life circumstances  

  • Therapist availability  

  • Ongoing life challenges  

  • The nature of your specific challenges and how you address them  

  • Personal finances  

You and your therapist will continually assess the appropriate frequency of therapy and will work together to determine when you have met your goals and are ready for discharge and/or a new "Good Faith Estimate" will be issued should your frequency or needs change.  

 

Disclaimers & Your Rights 

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.

 

The good faith estimate is not a contract and does not require any individual to obtain the items or services from any of the providers or facilities identified in the good faith estimate. 

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur.  

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. 

 

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019. 

Keep a copy of your Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.