Good Faith Estimate Rules
In accordance with the Public Health Services Act, health care providers and health care facilities are required to inform uninsured and self-pay individuals, both orally and in writing, of their ability to receive a good faith estimate of expected charges, either upon request or at the time a service is scheduled.
The term “health care provider” as set forth in Part II of the no surprise billing regulations means a physician or other health care provider who is acting within the scope of practice of that provider’s license or certification under applicable state law. Furthermore, the definition of items and services for which good faith estimates must be provided includes, “all encounters, procedures . . . and fees, provided or assessed in connection with a provision of health care.”
Good Faith Estimate Defined
A good faith estimate is a notification of expected charges for a scheduled or requested item or service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service. The expected charge for an item or service is the cash pay rate or rate established by a provider for an uninsured or self-pay patient, reflecting any discounts for those individuals.
Providers and health care facilities must furnish a good faith estimate of expected items or services on or after January 1, 2022 which will allow uninsured or self-pay individuals to have access to information about health care pricing before receiving care. The purpose of the good faith estimate requirement is to give individuals an opportunity to use the information to evaluate their health care options, manage care costs, and prevent surprise billing.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1800-985-3059.