If you see any self-pay or out-of-network clients in New York, the federal No Surprises Act requires you to give them a Good Faith Estimate. Many therapists either do not know this or are doing it in a way that would not hold up. Here is what the rule actually requires, what it does not, and a simple way to stay compliant without adding paperwork to every session.
Who needs a Good Faith Estimate
Any client who is uninsured or who is not using insurance for your services. That includes clients who have insurance but choose to pay out of pocket, and out-of-network clients who submit superbills themselves. If you are in-network and billing the plan, the GFE requirement does not apply to that client.
What it must include
- Your name, NPI and tax ID
- The client’s name and date of birth
- A description of the service and the expected diagnosis code (or a note that it is not yet known)
- The expected cost per session and an estimate for the expected course of treatment
- A statement that the estimate is not a contract and that costs may change
- A disclaimer about the client’s right to dispute a bill that exceeds the estimate by $400 or more
When it must be given
Within three business days of a request, or at least one business day before a scheduled service when scheduled three or more days out. In practice: send it with your intake paperwork, before the first session.
The mistakes we see most in New York practices
- Giving a single-session estimate only. The rule expects an estimate for the expected course of care, which for therapy means a reasonable number of sessions over a period, with a note that it will be updated.
- Not updating it. If your fee changes or the treatment plan changes significantly, issue a new one.
- Not keeping a copy. Keep the GFE in the client record for at least six years.
- Forgetting sliding scale clients. They are self-pay. They need one too.
The simple compliant workflow
Build a GFE template in your EHR with your fee, a 12-month course of weekly or biweekly sessions, and the required disclaimers. Attach it to the intake packet. Re-issue it annually and whenever fees change. That is five minutes per new client and zero per session afterward. MBBCS sets this up as part of practice policies for every New York client.
Quick answers
Do therapists in New York have to give a Good Faith Estimate?
Yes, to any client who is uninsured or not using insurance for your services, under the federal No Surprises Act. In-network clients billed through their plan do not need one.
How many sessions should a therapy Good Faith Estimate cover?
A reasonable expected course of treatment, commonly presented as a 12-month estimate at your fee and expected frequency, with a note that it will be updated as the plan changes.
What happens if I do not provide a Good Faith Estimate?
The client can dispute any bill that exceeds the estimate by $400 or more, and regulators can take enforcement action. The bigger risk is simply losing the dispute with no estimate on file.
Ready to talk? MBBCS is a clinician-owned practice management team in Brooklyn serving therapists across New York. Book a free 20-minute consult or get a ballpark estimate in 30 seconds.
