Good Faith Estimate
The No Surprises Act (H.R. 133), effective January 1st, 2022, requires that health care providers provide an estimate of the bill for any medical items or services to clients or patients who do not have insurance or who are not using insurance. At ClearMinds, we are committed to complying with this act and ensuring transparency in our billing process.
As part of our commitment to providing you with clear and accurate financial information, we offer a Good Faith Estimate for the total expected cost of any non-emergency items or services. The Good Faith Estimate provides an overview of the costs associated with your specific health care needs based on the information known at the time the estimate was created. It helps you understand the reasonable costs that you can anticipate for your treatment.
It’s important to note that the Good Faith Estimate does not include any unknown or unexpected costs that may arise during your treatment. In certain situations, complications or special
circumstances may occur, which could result in additional charges. However, under federal law, you have the right to dispute (appeal) the bill if it exceeds $400 more than the estimated amount provided in the Good Faith Estimate.
If you receive a bill that exceeds the estimated amount by $400 or more, you have the right to dispute it. You can contact our health care provider or facility to discuss the discrepancy and request an update to the bill that aligns with the Good Faith Estimate. You also have the option to negotiate the bill or inquire about the availability of financial assistance.
In case you decide to initiate a dispute resolution process, you can do so through the U.S. Department of Health and Human Services (HHS). Please note that the dispute process must be initiated within 120 calendar days (approximately 4 months) from the date of the original bill, and there is a $25 fee associated with using the dispute process. If the reviewing agency agrees with your dispute, you will be required to pay the amount specified in the Good Faith Estimate. However, if the agency sides with the health care provider or facility, you will be responsible for paying the higher amount.
To ensure you receive the Good Faith Estimate within the required timeframes, please note the following:
- If the service is scheduled at least three business days before the appointment date, you will receive the Good Faith Estimate no later than one business day after the date of scheduling.
- If the service is scheduled at least 10 business days before the appointment date, you will receive the Good Faith Estimate no later than three business days after the date of scheduling.
- If you request a Good Faith Estimate without scheduling the service, you will receive it no later than three business days after the date of your request. If you reschedule the requested item or service, a new Good Faith Estimate will be provided within the specified timeframes.
We want to emphasize that the Good Faith Estimate is not a contract, and it does not obligate you to obtain the items or services from our provider.
To learn more about the No Surprises Act, initiate a dispute, or obtain the necessary forms, you can visit www.cms.gov/nosurprises or call 800-985-3059. If you have any questions or require further information about your right to a Good Faith Estimate or the dispute process, please visit the provided website or call the same number.
We recommend keeping a copy of this Good Faith Estimate in a safe place or taking pictures of it. This documentation may be necessary if you are billed a higher amount and need to reference the estimated costs. If you have any questions or concerns, please do not hesitate to let us know. We are here to support you throughout your treatment journey.