Easy Ways to Create Good Faith Estimates for Therapists

Do you know if you’re up to date with the ever-evolving regulations affecting mental health counselors and therapists?

One of the most recent legislations passed in 2020 was the No Surprises Act. This act aims to reduce the number of disputes around fees between healthcare providers and clients.

So how does this affect you and your practice? 

When the legislation went into effect in 2022, the Good Faith Estimate (GFE) came into play. The GFE is an estimate from you, the healthcare provider, of the costs a client can expect for up to 12 months of care. 

We know you’d rather spend time with your clients, doing what you’re good at. Let’s face it, you’re probably thinking, “Great, another piece of paperwork.” That's exactly why we created the GFE Calculator tool. You can access this tool with a free 30 day trial to our Pro subscription. 

If you haven’t heard of the GFE or aren’t sure what exactly it is or how to create one, Clarity Cooperative is here for you. We have a community forum filled with therapists, and the latest resources. We’ll go through an overview of the act and how to create an easy GFE here. For more detailed information check out our post “GFE: What Therapists Need to Know.” 

No Surprises Act 

The goal of the No Surprises Act is to keep clients from receiving “surprise” medical bills. It also keeps the client out of billing dispute process between healthcare providers and insurance companies. The No Surprises Act ensures that you're being transparent about fees by providing a GFE. This helps to potentially avoid any shocking medical bills.

As a therapist, I’m sure you want your clients to be comfortable paying for their sessions with you. As we know, finances can be a major stressor for many people. This way they can ideally better plan for expenses throughout the year. 

Good Faith Estimates for Therapists

A Good Faith Estimate is meant to give clients an idea of their out-of-pocket costs for upcoming medical care. For therapy sessions, it is for clients that self-pay or don’t have in-network insurance coverage. 

While the estimate should be put together in good conscience, it doesn’t have to be perfect. After all, you can only plan for what you know. There will inevitably be some difference in the actual total cost of sessions from the GFE. As long as the total cost isn’t $400 or more than the GFE, you’re clear from any potential disputes. 

Not All Therapy Clients Require a GFE

The GFE should be provided by licensed or certified healthcare professionals. These are given to clients that self-pay for services or decide not to use their insurance. If any client, whether insured or not, requests a GFE you should provide one within 3 business days.  

Clients that use their insurance to cover the cost of services don’t require a GFE, but you can provide one if you’d like to. The Department of Health and Human Services doesn’t currently require one for them. Though, that could change in the future. 

GFE for Therapists: Information You Must Include

The GFE doesn’t need to be perfect. “Good faith” suggests that a sincere attempt was made at creating an estimate. This means there is no guessing with the prices. A disclaimer included at the end of the estimate can suggest that the total cost could be different.  

We created a GFE Calculator tool to help easily create a document to deliver to your clients. Our form includes all the information needed. Add you and your client’s personal information, and it’s ready to send or print. 

Here are some of the details you need to include on a GFE:  

1. Client Information: Name, Date of Birth
2. Primary Service: Short, simple explanation, Date of scheduled appointment (if available)
3. Treatment Plan: All services, fees associated & total costs, and frequency of sessions
4. Codes: Expected diagnosis codes, and service or CPT codes
5. Provider Information: Name and Contact, National Provider Identifier (NPI) and Tax ID Number (TIN)
6. Disclaimer that the estimate may be different from the actual total costs for that time period.

If therapy sessions or treatments continue past a full year, a new GFE is provided. One should be given every year following. The client’s actual, rather than expected, diagnosis codes are included this time. If any client asks for an updated quote, you can provide a new one within 3 business days.

How To Write a GFE for Therapists

Here are a few steps you can take before preparing the actual GFE. These will help save time by avoiding going back and forth with your client:

1. Gather the client's identifying information. Also, ask how they plan on paying for therapy sessions. You don’t need to provide a GFE if the client is using insurance that you are in-network with. Government funded healthcare clients (Medicaid or Medicare) also don't need a GFE. If you ask your client about this first, you can avoid doing anything else.
2. Inform the clients that are self-paying or uninsured that a GFE will be provided. You can also ask them what method of delivery they prefer. Notices should also be posted in the office and on your website so that they’re easily accessible.
3. Determine the delivery method you’ll use to send the GFE:

• Verbal - It is possible to deliver an estimate verbally, but it's good practice to also provide it in writing. It can be either digital or a hard copy so that you can store it in the client's records. 
• Digital - If your client has consents to electronic communication, this is a convenient method of delivery. Email is an option, and many EHR systems now offer secure portals for messaging clients. 
• Paper - GFEs can be mailed or handed directly to the client. Just keep in mind there is a suggested time frame for delivery of the estimate. Depending on the situation this may not always be the most convenient.

Easily Incorporate GFEs into Your Practice

Good Faith Estimates are an essential part of running our practices now. Luckily, there are resources and tools available to help us. It could also be beneficial to have a few routines in place so we don’t forget about providing them. 

The GFE Calculator tool on our website is plug-and-play. You can select CPT codes with brief descriptions already included. Then, customize the cost and frequency of services. A total fee amount is automatically populated, and we even included a disclaimer. All you need to do is add in you and your clients private information. 

Stay organized by setting time aside time on a regular basis to work on GFEs. Once a month, or once a quarter are good guidelines for existing clients. Going through all the clients that need updates within a certain time frame is much easier. Otherwise, you'll have to find a way to keep track of who needs one each day or week. 

A GFE is part of a client’s medical record and should be kept together with the rest of their documents. Note the date and delivery method of the GFE in their files. This will help make it easy to reference. 

Notify clients that they have the right to a GFE. You can post notices in areas where clients are likely to look for information. This could include your website, intake forms, office, the front desk, or waiting area. 

GFE for Therapists and Other Considerations

The requirements for creating and delivering GFEs can seem complex. It's still new to most of us, so its understandable. Here are a few scenarios you may come across, where you might feel unsure of what to do: 

Self Pay Clients with $0 Fees

Even if expected total charges are $0, if your client is self-paying or uninsured, a GFE is still required. Though, if any changes happen and there is a fee, you can provide an updated estimate.

Insurance Expires or Changes after Booking 

To avoid surprises, ask about the client's insurance before booking their appointment. Situations can happen like job loss or changes in insurance. Whatever the reason is, if a client's coverage changes for any reason, you can provide a new GFE. If their insurance lapses within three business days of an appointment, you don't need to provide it before then. Do try to have your clients keep you up to date on any changes though. This way you can provide a GFE if the new situation requires it. 

GFE in Different Languages

We live in a diverse country and some of us may see clients that don’t speak English as their first language. Estimates should be in the language that is easiest for the client to understand. If you think that your client might want the GFE in another language, you can politely ask. 

Treatment Plan Changes

Life happens, and that means that a client might need to see you more often for a period of time. Or diagnostic and treatment codes might need to be changed. You can make updates to the GFE in the middle of an ongling treatment plan. A good practice is to have it delivered at least one day before their next session. 

Forgot to Send a Therapy GFE

There aren’t any financial penalties in place right now if you forget to send GFEs. Though, formal inquiries could still be made. That doesn't mean you get a free pass to not do them though. Getting into good practices ahead of the game can help you avoid any annoying penalties. , should there be fees in the future, can help you avoid any annoying fees or trying to learn to put a GFE together in a rush. 

Found Errors on a GFE Already Delivered

Mistakes do happen, as we’re human. If you or your client notices an error on a GFE that's already been sent try to 

correct it and send an updated one as soon as possible. 

If a client is unhappy about the total amount of actual expenses for your services, they’re able to file a dispute. A third party dispute resolution process will unfold. If the total amount is $400 or more than on the GFE, the third party will investigate. They'll look at the bills, the GFE, and additional documentation that you provide. They will determine whether the client will pay the amount billed, on the estimate, or another value somewhere between. 

Keeping the GFE and Intake Forms Separate

The intake form is a great place to collect the client’s personal and insurance information. While the GFE is a part of their medical record, it's likely best kept separate from the actual intake itself. Even if intake forms are sent to a client well before their first appointment, ther'es no guarantee they'll complete them. Some could wait until the day of the appointment. You also might not have all their information to include on the estimate yet. The GFE does need to be provided within a certain time frame depending on when the appointment was booked. The intake forms aren't quite as strict and can be completed right before the session.  

How to Write a GFE for Therapists with Support from The Cooperative

Providing GFEs to clients has become an important part of running a therapy practice. The estimate allows the client to make educated decisions about their healthcare costs. 

At Clarity Cooperative we understand that this might add more work and potentially stress to your plate. We're here to help you thrive in private practice. With our GFE calculator, you can spend less time worrying about paperwork, and more time with clients.

Check out some of our other tools and resources available for you in our practice toolbox with a free trial to our Pro subscription for two weeks. 

We also welcome you to say hello in our community forum of therapists and healers where we support each other at any stage of our career.