Good Faith Estimates for Therapy: Your Rights Under the No Surprises Act

As of January 2022, you have a legal right to receive a cost estimate before starting therapy — even if you plan to pay out of pocket. This is called a Good Faith Estimate (GFE), and it's required under the No Surprises Act. Here's what the law requires, how to get one, and what to do if your therapist doesn't provide it.

What Is a Good Faith Estimate?

A Good Faith Estimate is a written statement from a healthcare provider — including therapists — that outlines the expected cost of your care before treatment begins. It isn't a bill. It's a forward-looking cost estimate that lets you understand what you're likely to pay over the coming period.

The GFE requirement was created to protect patients from unexpected medical bills, a practice sometimes called "surprise billing." While most of the No Surprises Act was designed for emergency and hospital care, the GFE requirement applies broadly — including to outpatient mental health services.

Who Is Entitled to a Good Faith Estimate?

You are entitled to a Good Faith Estimate if:

• You are uninsured and paying out of pocket, OR
• You are insured but choosing not to use your insurance for the services (for example, if you're paying privately for therapy to keep it off your insurance record)

Important: if you plan to submit claims to your insurance company — including submitting superbills for out-of-network reimbursement — the GFE rules in their current form are primarily intended for self-pay situations. However, many therapists provide GFEs to all new clients as a matter of good practice.

What Must the Good Faith Estimate Include?

Under the No Surprises Act regulations, a Good Faith Estimate for therapy must include:

• The provider's name, NPI, and address
• A description of the services to be provided
• The expected CPT codes and ICD-10 diagnosis codes
• The expected cost per service and the total expected cost for the period
• The date the estimate was issued and its expected period of validity

For therapy, this typically means listing the session CPT code (such as 90837 for 60-minute individual therapy), the fee per session, and an estimate of how many sessions are expected over the coming 12 months.

How to Request a Good Faith Estimate

When you schedule a new appointment with a therapist, you can request a GFE directly. If you are uninsured or self-pay, providers are required to offer one proactively, but in practice you may need to ask. Here's how:

1. Contact the therapist's office before your first session.
2. State that you are self-pay (or that you won't be using insurance) and that you would like a Good Faith Estimate as required under the No Surprises Act.
3. The provider must deliver the GFE within 3 business days of scheduling if the appointment is at least 3 days out, and within 1 business day if it's within 3 days.

What Happens If the Final Bill Is Much Higher Than the Estimate?

If you receive a bill that is $400 or more above the Good Faith Estimate, you have the right to dispute it through the Patient-Provider Dispute Resolution process. This is a federal process administered by the Department of Health and Human Services.

To start a dispute:

• You must act within 120 days of receiving the bill
• Submit the dispute through the HHS portal at cms.gov
• Pay a $25 administrative fee (refunded if the dispute is resolved in your favor)
• An independent reviewer will determine the appropriate payment amount

The GFE Is Not a Cap on Your Costs

A common misconception: the Good Faith Estimate is not a price guarantee. Your therapist can charge more than the estimate if treatment changes or continues longer than expected. The $400 threshold for dispute resolution exists as a safety valve, not as a hard limit. Think of the GFE as a planning tool — it helps you understand likely costs so there are no surprises.

How GFEs and Superbills Work Together

If you're using insurance to get reimbursed for out-of-network therapy, you'll need a superbill rather than just a Good Faith Estimate. The superbill is a retrospective receipt of services rendered. The GFE is prospective — it tells you what to expect before treatment. Both documents serve important roles in protecting patients from financial surprises, and they share many of the same data fields.

For help understanding what your insurance will actually pay for OON therapy, see our guide to out-of-network reimbursement.

Know Your Rights

The No Surprises Act is enforced by the Centers for Medicare and Medicaid Services (CMS). If you believe a provider violated your right to a Good Faith Estimate, you can file a complaint at cms.gov/nosurprises. Violations can result in civil penalties for providers. You should never feel embarrassed about asking for cost transparency — it's your legal right.