Good Faith Estimates HIPAA Compliant Know What to Expect Before You Receive Care At Bonmente, we believe mental health care should feel straightforward, including when it comes to understanding the cost of your care. If you do not have health insurance or choose not to use your insurance to pay for your care, you have the right to receive a Good Faith Estimate explaining how much your scheduled health care services are expected to cost. A Good Faith Estimate is designed to give you a clearer picture of your anticipated costs before you receive care and help protect you from unexpected medical bills. What Is a Good Faith Estimate? A Good Faith Estimate (GFE) is an estimate of the expected charges for health care items or services you are scheduled to receive. Under the federal No Surprises Act, health care providers generally must provide a Good Faith Estimate to patients who are uninsured or who are choosing not to use their health insurance to pay for their care when services are scheduled sufficiently in advance or when the patient requests an estimate. At Bonmente, your estimate may include the anticipated cost of services such as: Psychiatric evaluations Psychiatry follow-up appointments Medication-management visits Therapy appointments Other scheduled self-pay mental health services The exact services and charges included in your estimate will depend on the care you are expected to receive. Who Can Receive a Good Faith Estimate? You generally have the right to receive a Good Faith Estimate if you: Do not have health insurance, or Have health insurance but do not intend to use it to pay for the scheduled service. You can also ask for a Good Faith Estimate before you decide whether to schedule a service. A Good Faith Estimate is not a bill and does not require you to receive the services listed in the estimate. When Will I Receive My Estimate? Federal guidelines establish specific timelines for Good Faith Estimates. If you schedule care 3–9 business days in advance, the estimate generally must be provided within 1 business day after scheduling. If you schedule care 10 or more business days in advance, the estimate generally must be provided within 3 business days after scheduling. You can also request a Good Faith Estimate before scheduling care. In that situation, it generally must be provided within 3 business days after your request. If an appointment is scheduled fewer than three business days in advance, the federal Good Faith Estimate requirement may not apply to that appointment. What Does a Good Faith Estimate Include? Your Good Faith Estimate should provide an itemized description of the services reasonably expected to be provided and the anticipated charges associated with those services. Mental health treatment, however, isn’t always completely predictable. Your provider may recommend a different frequency of appointments based on your symptoms, medications, response to treatment, or changes in your condition. You may also decide to continue treatment longer, or for less time, than initially anticipated. For that reason, a Good Faith Estimate is an estimate based on the information available when it is prepared, rather than a guarantee of the exact amount you will ultimately pay. What If I Don’t Know How Many Appointments I’ll Need? That’s completely normal. Mental health care is individualized, and it isn’t always possible to know at the beginning of treatment exactly how many appointments you will need. Your treatment plan may change depending on your progress and clinical needs. For example, a patient beginning a new medication may temporarily need more frequent follow-up appointments, while someone who has been stable on a treatment plan may eventually need appointments less frequently. A Good Faith Estimate reflects the care that is reasonably expected at the time the estimate is created. If your treatment needs change substantially, your anticipated costs may change as well. Does a Good Faith Estimate Mean That’s Exactly What I’ll Pay? Not necessarily. A Good Faith Estimate is intended to provide a reasonable estimate of expected charges, not an exact prediction of every service you may ultimately receive. Your actual charges could differ if your treatment plan changes, you receive additional services, you schedule additional appointments, or circumstances arise that could not reasonably have been anticipated when the estimate was prepared. That’s why it’s helpful to keep a copy of your Good Faith Estimate and compare it with your final bills. What If My Bill Is Much Higher Than My Estimate? Federal law provides an additional protection for uninsured and self-pay patients. If you receive a bill from a provider or facility that is at least $400 more than the amount listed for that provider or facility on your Good Faith Estimate, you may be eligible to use the federal patient-provider dispute resolution process. An independent third party reviews qualifying disputes and determines an appropriate payment amount. There are deadlines associated with this process. CMS currently states that the initial bill must generally be dated within the previous 120 calendar days to qualify for the federal dispute process. You can learn more about Good Faith Estimates, your rights under the No Surprises Act, and the patient-provider dispute resolution process through the Centers for Medicare & Medicaid Services (CMS). What If I Have Insurance? Good Faith Estimate requirements discussed on this page primarily apply when you do not have insurance or are choosing not to use your insurance to pay for your care. If Bonmente is billing your insurance, the amount you ultimately owe can depend on your specific health plan, including your: Deductible Copay Coinsurance Network benefits Remaining benefits Plan exclusions or limitations Insurance benefits can change, and an insurance company’s verification of benefits is not necessarily a guarantee that a claim will be paid. If you’re unsure about your mental health benefits, we encourage you to contact your insurance company directly using the member-services number on your insurance card. Why Good Faith Estimates Matter Cost shouldn’t feel like a mystery. Good Faith Estimates are intended to make health care pricing more transparent and give patients more information before they receive care. They can help you understand your expected financial responsibility, plan for the cost of treatment, and identify significant differences between estimated and actual charges. Most importantly, asking for an estimate does not affect your ability to receive care. Questions About Your Estimate? If you are uninsured, plan to pay for your care yourself, or would like more information about the expected cost of your Bonmente services, please contact our team. We can help you understand our self-pay rates, scheduled services, and how to request a Good Faith Estimate. Please remember: A Good Faith Estimate is based on the information available at the time it is prepared. Your treatment plan may change based on your individual clinical needs, and additional or different services may result in different charges. Your Right to a Good Faith Estimate Under federal law, health care providers generally must provide patients who do not have insurance or who are not using insurance to pay for their care with an estimate of expected charges when qualifying services are scheduled or when an estimate is requested. If your final bill from a provider or facility is at least $400 more than that provider or facility’s Good Faith Estimate, you may have the right to dispute the bill. For additional information about your federal rights, visit the Centers for Medicare & Medicaid Services’ Medical Bill Rights resources or call the No Surprises Help Desk at 1-800-985-3059.
