Patient right to receive a Good Faith Estimate

Everything you need to know:

• Good Faith Estimate: A breakdown of a procedure’s estimated total cost provided for all self-pay patients when scheduling the surgery.
  • Effective 01/01/22 as part of the No Surprise Act
  • Any discussion of service cost will be treated as a “good faith estimate request”
• A Good Faith Estimate must include the patient’s name, primary service, itemized list of all services, diagnosis codes, and any anticipated services outside of the surgery itself
• True self-pay:  Anyone who is un-insured or chooses not to submit the claim to their insurance
• Timeframe of conducting and providing a Good Faith Estimate
  • Must be provided to the patient within three business days if surgery is scheduled at least ten days prior
  • Must be provided to the patient within one business day if surgery is scheduled three business days prior
• Changes to a Good Faith Estimate are allowed. If changes are necessary, the updated estimate must be provided to patient at least one day before scheduled services.
• Patients must be made aware and understand that this is an estimate and the actual charges may differ via disclosure attached to the estimate
  • If the actual charges differ more than $400 dollars than the initial estimate, patients are within their rights to dispute the bill 
• ASCs must have a written physical and electrical copy of a self-pay patient’s right to a Good Faith Estimate accessible in the office, on the official website, and wherever the surgeries are being scheduled.