Description
Good Faith Estimate Forms
Under the Federal No Surprises Act (NSA)*, all health care providers are required to give clients who don’t have insurance or who are not using insurance, an estimate of the expected charges for medical services, including psychotherapy services. The intent is to provide accurate information regarding their expected health care spending and to prevent unexpected or surprise billing. You’ll need 3 forms to fulfill this requirement.
- The Good Faith Estimate (GFE) explanation of the law. It’s necessary to put it on your website and display it in your office.
- The Good Faith Estimate for Behavioral Health Care and Disclaimer This form explains in detail, the estimated cost of treatment for 1 year and is signed by the client.
- A No Surprises Act letter or email that explain the GFE to your existing private clients.
These forms have been reviewed by an attorney and a bioethicist. They have been developed to meet the needs of psychotherapists. Cues are provided so you know where and how to customize them for your practice and clients. Attorney and bioethicist approved for psychotherapists! Valued at: PRICELESS! Can’t live without it!
* Title I (No Surprises Act) of Division BB of the Consolidated Appropriations Act, 2021 (CAA) amended title XXVII of the Public Health Service Act (PHS Act)
Prompts
Includes List of Intervention Prompts as well as List of Progress Prompts