A Good Faith Estimate is a written list of the charges a provider expects for your care, given before you receive it. Under the federal No Surprises Act, providers usually must give you one if you don't have insurance or are choosing not to use it, either when you schedule care at least 3 business days ahead or when you ask.
Part of our guide: Getting Started With Mental Health Care
It helps answer the practical question behind private-pay care: what will this cost me? Private-pay fees can differ by clinician and service, so an estimate from the practice you are considering is more useful than any general figure. It can also give you a federal dispute option if a bill comes in at least $400 above the estimate. This is general information about a federal rule, not legal or billing advice.
Who can get one
The federal regulation uses the phrase "uninsured (or self-pay)". In plain terms, that covers two groups:
- People who have no coverage for the service
- People with a private or employer plan who do not want a claim submitted to it for that service
Tell the office before your care that you are not using insurance. CMS lists that as one of the conditions for disputing a bill later. CMS says people enrolled in federal programs, including Medicare and Medicaid, are not entitled to an estimate, even if the service isn't covered or they don't intend to use their coverage.
What if you plan to seek out-of-network reimbursement?
This catches many mental health patients. CMS says you are only given an estimate if you aren't using insurance to pay for your care, and that if you used health insurance, you don't qualify for this dispute process. Federal materials describe self-pay patients as those who do not intend to submit a claim to their coverage, and New York regulators say much the same. So if a practice files an out-of-network claim for you, or you plan to submit a superbill, these rights may not apply to that care. If your plan has no benefits for the service at all, you may still fit the first group above.
The federal pages don't cover every arrangement, such as deciding to file a claim after care. So if you might submit claims or a superbill, say so and ask two questions: "Can I still have a written estimate?" and "Would submitting a claim change my dispute rights?" The No Surprises Help Desk at 1-800-985-3059 can answer questions about your situation.
When you should receive it
Timing depends on how far ahead you book. Here is what CMS lays out, and the regulation matches:
| Situation | Estimate due |
|---|---|
| Scheduled 3 to 9 business days ahead | Within 1 business day of scheduling |
| Scheduled 10 or more business days ahead | Within 3 business days of scheduling |
| You ask for one, even before scheduling | Within 3 business days of your request |
| Scheduled 0 to 2 business days ahead | Not required at scheduling |
You do not need to know the official term. CMS says you don't need to use the words "Good Faith", and the regulation says any discussion or inquiry about potential costs should be treated as a request. Asking for it in writing still makes sense, because you need a written copy to dispute a bill.
What should be on it
The regulation lists the required contents. Look for:
- Your name and date of birth
- A clear description of the main service and its date, if scheduled
- An itemized list of expected services, with service codes and expected charges
- The provider's name, National Provider Identifier and Tax ID, and where care will take place
- A statement that this is only an estimate and that actual charges may differ
- A statement about your right to dispute, and that disputing will not affect the quality of your care
- A statement that the estimate is not a contract and does not require you to get care from that provider
If you are worried about privacy, note that HHS says a diagnosis code is not required when no diagnosis has been determined, such as for an initial screening or evaluation visit. The estimate is treated as part of your medical record, and you can request a copy of past estimates issued in the last 6 years.
How it works for ongoing therapy and psychiatry
Most examples of estimates describe a one-time surgery. Mental health care is usually a series of visits, and a few rules matter more here.
A first-visit estimate may not include later visits
HHS says providers don't have to include future visits in the estimate for an initial visit, unless they are reasonably expected to go with that visit. An estimate for a psychiatric evaluation may tell you little about the cost of follow-ups.
Recurring care can go on one estimate
For regular services, such as periodic counseling, a provider may issue a single estimate. It must describe the expected scope, such as how often and how many visits, and cannot cover more than 12 months. Your clinician can only estimate this, since nobody knows at the start exactly how long care will last. How Often Should You Go to Therapy, and for How Long? can help you think about realistic scenarios.
Each provider may be listed separately
CMS says estimates currently list charges for a single provider or facility. If you see a therapist and a psychiatrist, or if an outside lab or testing service is involved, ask each one. Lab work or medication costs may not appear on a clinician's estimate at all.
Changes should mean a new estimate
If the expected charges, frequency or duration change before scheduled care, the provider must issue a new estimate no later than 1 business day before the service.
Planning your private-pay budget
An estimate gives you figures. To turn those into a realistic budget, ask what is likely to drive your total:
- The first evaluation. It may be longer and priced differently from follow-ups.
- Visit frequency. Ask what is typical at the start and whether it usually tapers.
- Who you see. Fees can differ by clinician type and experience.
- Add-ons. Ask about testing, letters, forms, between-visit calls and records.
- Costs from others. Pharmacy and outside lab bills usually come separately.
- Cancellation policies. These can add cost, and they may not appear on an estimate.
Then work through a first three months using the frequency your clinician suggests, and leave some room for changes. For a fuller look at planning, see What Integrative Psychiatry Costs and How to Plan.
What the estimate does not protect you from
An estimate is not a price cap, and it isn't a bill. It may leave out care scheduled separately or not anticipated. Federal surprise billing protections are a separate set of rules, aimed at situations such as emergency care and out-of-network clinicians at in-network hospitals. They generally do not address a planned visit to a private office. In that setting, your written estimate and your own plan documents are often the main tools you have. New York has its own surprise bill rules, which can reach some referrals from an in-network doctor to an out-of-network provider, so check them if that applies to you.
If your bill is much higher than the estimate
Compare the bill to the estimate from that same provider. If it is at least $400 higher, you may be able to use the federal patient-provider dispute process. According to CMS:
- Start within 120 calendar days of the date on your initial bill. Don't wait.
- Have copies of the estimate and the bill, along with the provider's contact information. CMS also lists an estimate received 3 days before your scheduled appointment as a condition, so if yours came later, ask the Help Desk.
- Pay the $25 non-refundable administrative fee. If you win, it comes off what you owe.
- An independent third party reviews the bill and sets an appropriate payment.
Your costs won't increase because you disputed, and the provider can't send the bill to collections or act against you for disputing while the process is open. The reviewer can still uphold some or all of the higher charge if the provider shows the extra care was medically necessary and couldn't reasonably have been expected.
It is also reasonable to call the billing office first and ask about the difference. If you never received an estimate and should have, CMS says you can submit a complaint, though you can't use the dispute process without an estimate.
How to ask for one
A short message is enough: "I'm planning to pay without using insurance. Please send me a written estimate of expected charges for the first evaluation and for the visits you expect after it." If you get care from more than one clinician, ask for each. Keep the estimate where you can find it, and save a photo as a backup.
Requesting an estimate at Mind Body Seven
A Good Faith Estimate is available on request at Mind Body Seven, and you can talk through costs with the practice before starting care. See the fees and insurance page for how fees, out-of-network claims and superbills work there, or read Questions to Ask Your Insurer if you are weighing whether to use your benefits.
FAQs
Do I have to pay the amount on the estimate?
No. The estimate is not a bill and not a contract. It does not commit you to care from that provider, so you can use it to compare options.
Can I get an estimate from a practice before deciding to book?
Yes. CMS says you can ask before you schedule, and the provider must send it within 3 business days of your request.
Does the estimate apply to telehealth visits?
The federal rule is written around scheduled items and services and does not exclude telehealth; its definition of a period of care mentions telemedicine services. Ask the office to list the visit type you expect.
What if I lose my estimate?
Ask the provider for a new copy. CMS advises this, and providers must keep estimates as part of your medical record and provide copies of those issued in the last 6 years on request.
