What is a Good Faith Estimate?

Beginning in January 2022, healthcare providers are required to provide an estimate of costs to clients who are paying for services without using their insurance plan. Teen Therapy OC Family Counseling Inc. (hereafter Teen Therapy OC) will provide you with a written estimate of what your costs could be if you come to counseling. The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from any of the providers or facilities identified in the Good Faith Estimate. For detailed information on this law visit cms.gov/nosurprises.

What can I expect to pay at Teen Therapy OC?

A client can expect to be billed at the time of each session. The rate of each session is as stated in the FAQs, and in the informed consent that is reviewed and signed at the outset of treatment. Clients are also welcome to request an updated Good Faith Estimate at any time.

Will my insurance cover this?

Therapists at Teen Therapy OC do not accept any form of insurance and are not in-network providers. Your therapist is able to provide a monthly superbill if you wish to submit an out-of-network claim to your insurance. Teen Therapy OC cannot guarantee that your insurance will reimburse payment. You are strongly encouraged to check with your insurance provider to determine whether you will receive any reimbursement from your insurance company.

Associate level therapists at Teen Therapy OC have not yet sat for their licensing exam and are supervised by a licensed therapist. Your associate therapist will gladly provide you a superbill to seek out of network reimbursement, but insurance companies might deny these claims based on the fact that your associate provider is not yet licensed.

H.R. 133 Legal Disclaimers

A Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.

There may be additional items or services the provider recommends as part of the course of care that must be scheduled or requested separately and are not reflected in the Good Faith Estimate.

The information provided in the Good Faith Estimate is only an estimate and actual items, services, or charges may differ from the Good Faith Estimate.

The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from any of the providers or facilities identified in the Good Faith Estimate.

If you receive a bill that is at least $400 more than your Good Faith Estimate, please try to resolve it with your provider first, but know you can dispute the bill. To learn more and get a form to start the process, go to www.cms.gov/nosurprises. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019.

You may start a bill dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

Do you have a question that wasn’t answered?  Call 949-394-0607 and we will gladly help you.