Right to Receive a Good Faith Estimate of Expected Charges
No Surprises Act
Good Faith Estimate (GFE)
The No Surprises Act (NSA) is a federal law that protects patients from unexpected
medical bills. It went into effect on January 1, 2022. Healthcare providers and
healthcare facilities are required to inform individuals who are not enrolled in a plan or
coverage or a Federal healthcare 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.
As you may know, it is difficult to determine the length of treatment for mental health
care and each client has the right to decide how long they would like to participate in
mental health care. Therefore, the GFE you will receive will include a fee schedule for
the services offered by Chesapeake Behavioral Health Center.
This form may be used by the health care providers to inform individuals who are not
enrolled in a plan or coverage or a Federal health care program (uninsured individuals),
or individuals who are enrolled but not seeking to file a claim with their plan or coverage
(self-pay individuals) of their right to a “Good Faith Estimate” to help them estimate the
expected charges they may be billed for receiving certain health care items and
services. Information regarding the availability of a “Good Faith Estimate” must be
prominently displayed on the convening provider’s and convening facility’s website and
in the office and on-site where scheduling or questions about the cost of health care
occur.
You have the right to receive a “Good Faith Estimate” explaining how much your
medical care will cost
Under the law, healthcare providers need to give patients who don’t have insurance or
who are not using insurance an estimate of the bill for medical items and services.
● You have the right to receive a Good Faith Estimate for the total expected cost of
any non-emergency items or services. This includes related costs like medical
tests, prescription drugs, equipment, and hospital fees.
● Make sure your healthcare provider gives you a Good Faith Estimate in writing at
least 1 business day before your medical service or item. You can also ask your
health care provider, and any other provider you choose, for a Good Faith
Estimate before you schedule an item or service.
● If you receive a bill that is at least $400 more than your Good Faith Estimate, you
can dispute the bill.
● Make sure to save a copy or picture of your Good Faith Estimate so you can
compare it with any bill you receive.
For questions or more information about your right to a Good Faith Estimate, visit
www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.