Intrinsic Counseling and Treatment Center will provide an estimate of the bill for medical items and services for clients who are privately paying or not filing a claim to the health insurance as required by the No Surprises Act (H.R. 133 - effective January 1, 2022).

The “Good Faith Estimate” is an estimate of the total costs of the overall care you can reasonably expect.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.

By Law, if the service is scheduled at least three business days before the appointment date, you are required to receive your Good Faith Estimate no later than one business day after the date of scheduling. 

• If the service is scheduled at least ten business days before the appointment date, you are required to receive your Good Faith Estimate no later than three business days after the date of schedule; or

• If the uninsured or self-pay client requests a Good Faith Estimate and does not schedule services, you are required to receive your Good Faith Estimate no later than three business days after the date of the request.

•  Healthcare providers must supply a new GFE within the specified timeframes if the patient reschedules the requested item or service.

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You may experience additional charges if complications or exceptional circumstances occur. 

If you receive a bill that is at least $400 or more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

• You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You may ask them to update the bill to match the Good Faith Estimate, negotiate the bill, or ask if financial assistance is 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 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. 

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.

If you have questions or concerns, please reach out.