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What is an Example of a Good Faith Estimate in Healthcare?

A good faith estimate (GFE) in healthcare is a document provided to clients, outlining the expected costs of services they will receive. You’re probably wondering what the good faith estimate requirements are for mental health professionals. For therapists in private practice, it includes an itemized breakdown of services such as therapy sessions, assessments, and other potential charges. To make things easier for your practice, you can access a free good faith estimate form that is attorney-approved and designed for therapists in private practice. This free printable good faith estimate form can also be used digitally. Get your free Good Faith Estimate template here.


The good faith estimate template helps clients understand their financial responsibility before services are rendered, reducing surprises when it comes to cost. For example, a GFE created by a therapist would include the cost per session, any additional fees for missed appointments, or costs associated with assessments or extended consultations.


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Who is Required to Comply Under The ‘No Surprises Act”?


The No Surprises Act, effective since January 1, 2022, applies to all healthcare providers, including therapists and psychologists in private practice, who provide services to uninsured or self-pay clients. This means that if you are a licensed therapist who does not participate in insurance networks and sees clients who are uninsured or pay out of pocket despite having insurance, you are required to provide a GFE to these clients before delivering services.

Therapists are obligated to comply with this law in an effort to increase transparency and fairness in billing. Non-compliance can result in penalties and legal issues. To protect your practice, it's essential to understand the requirements for a good faith estimate form for therapists in private practice and implement them effectively. 


Providing a good faith estimate form for therapists in private practice not only keeps you compliant but also helps clients feel more secure in understanding the cost of their care.


What Steps Do Therapists Need to Take and When to Comply with the No Surprises Act?


Therapists need to take specific steps to comply with the No Surprises Act. First, therapists should inform their clients that they are entitled to receive a good faith estimate before services begin. The GFE must be provided both in writing and electronically (if requested), at least three business days prior to the first appointment.


Here are some key steps therapists must follow:

  1. Notify clients of their right to a GFE.

  2. Provide the estimate within three business days of scheduling the service.

  3. Update estimates as necessary if the scope or cost of services changes.

  4. Keep documentation of the estimates and any changes for at least six years to meet legal requirements.


At Private Practice Startup, our goal was to create a system for therapists using a good faith estimate template for therapists to streamline this process, ensuring every client receives the required documents in a timely manner.


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How Do You Write a Good Faith Estimate Form and What Should It Contain?


Creating a good faith estimate form for therapists in private practice involves more than just listing services and costs. It should be a comprehensive document that covers all aspects of the services you plan to provide. Here’s a breakdown of what should be included in a good-faith estimate:


  1. Client Information: Full name, contact details, DOB, and phone number.

  2. Provider Information: Your name, the name of your practice, contact information, EIN or NPI if you have one.

  3. Description of Services: Clearly list each service you provide, such as individual therapy sessions, group therapy, assessments, or evaluations.

  4. Costs of Each Service: Include the price for each service, whether it’s charged per session, per hour, or as a package. For example, the cost of each therapy session, fees for missed appointments, and any other applicable charges.

  5. Frequency and Duration: Indicate how often the services will be provided (e.g., weekly sessions) and the expected duration of treatment.

  6. Total Estimated Costs: Add up all the services and provide a total cost estimate. Ensure this total reflects the expected charges over the course of treatment.

  7. Disclaimer: Include a disclaimer noting that the estimate is not a contract and that actual charges may vary based on changes in the client’s treatment needs. The disclaimer also needs to instruct the client on how they can dispute the bill should what they are being charged and the GFE is $400 over what the GFE indicates. 


By using a good faith estimate template, therapists can simplify this process, ensuring all required elements are included while maintaining consistency across clients.


How Long Is a Good Faith Estimate Good For?


A good faith estimate is valid for 12 months from the date it is provided to the client. This means that if the treatment plan changes, or if services extend beyond 12 months, the therapist may need to issue a new GFE to reflect any updates in pricing or services.

Additionally, if the client requests additional services that were not included in the original estimate, or if there are significant changes to the treatment plan, the therapist should provide an updated good faith estimate. This ensures that clients remain informed about the financial aspects of their treatment at all times.


What Next Steps Should I Take Regarding Complying with GFE Requirements?


Understanding and complying with the No Surprises Act is crucial for therapists in private practice. By offering clients transparency and clarity through a good faith estimate, you build trust and avoid potential legal issues. It’s essential to know who is required to comply, what steps need to be taken, and how to create an accurate and comprehensive GFE for your clients. Using tools like a good faith estimate template for therapists can make this process more manageable and ensure you meet all legal requirements.


To assist you in this, we offer a FREE Attorney-Approved Good Faith Estimate Template for therapists in private practice. This template will help you easily provide estimates to your clients and ensure you remain compliant. Download your free template here.


Looking for a complete paperwork solution for your private practice? Grab our Attorney-Approved Private Practice Paperwork Bundle that includes everything from Good Faith Estimates to intake forms, HIPAA forms, and more. Get your bundle here.


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Simplify Your Practice with Our Good Faith Estimate Template and Complete Paperwork Bundle


Looking for a seamless way to meet Good Faith Estimate (GFE) requirements in your private practice? At The Private Practice Startup, we offer an Attorney-Approved Good Faith Estimate Template to simplify compliance and keep your clients informed about their costs. For an all-in-one solution, grab our Private Practice Paperwork Bundle—it has everything you need, from intake forms to HIPAA documents, helping you streamline your practice with ease. Let us help you focus on what you do best—caring for your clients! Follow these three simple steps to get started:


  1. Have Questions? – Reach out to us at Kate@ThePrivatePracticeStartup.com for any inquiries or clarifications on how the Good Faith Estimate Template or our comprehensive paperwork bundle can benefit your practice.


  1. Get Your Free Template – Download our Attorney-Approved Good Faith Estimate Template for therapists, or explore our full private practice paperwork bundle, which includes everything you need to customize for your practice and stay compliant.


  1. Start Today – Simply download, fill in your practice details, and begin providing clear, compliant estimates to your clients. Plus, use our complete bundle to streamline all your essential paperwork needs!


Additional Services from The Private Practice Startup


At The Private Practice Startup, we’re dedicated to providing the resources and guidance necessary for your private practice to thrive. In addition to our essential paperwork for private practices, we offer supervision forms specifically designed for mental health professionals, and a detailed Private Practice Marketing E-Course to help you attract and retain clients. Be sure to explore our Private Practice Startup Podcast, where we interview top experts, successful therapists, and entrepreneurs to inspire and guide you at every phase of your practice. No matter where you’re located—whether in Texas, California, New York, Florida, or beyond—we’re here to help you succeed.


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