Good Faith Estimate
No Surprises Act & Good Faith Estimates
Right to Receive a Good Faith Estimate of Expected Charges (for Clinical Services only)
Under the No Surprises Act (implemented January 1, 2022)
Under Section 2799B-6 of the Public Health Service Act, 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.
A Good Faith Estimate involves a healthcare provider giving a patient, who is uninsured or plans to pay out-of-pocket, a detailed written estimate of the expected costs for a scheduled medical service or item, including any reasonably anticipated related services, before they receive care, allowing them to compare costs and potentially negotiate with the provider if the final bill significantly differs from the estimate; this is primarily mandated by the No Surprises Act
The Good Faith Estimate shows the costs of items and services that are reasonably expected for your mental health care needs. 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. If this happens, federal law allows you to dispute (appeal) the bill.
If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may contact Inner Path Wellness to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
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.
There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 1-800-985-3059.
Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount without being notified before services.
This Good Faith Estimate is not a contract and does not require you to obtain the items or services from Inner Path Wellness.
If you have any questions or need further clarification, please don't hesitate to contact us.
We are here to assist you on your wellness journey.
Thank you for choosing Inner Path!
