Important: The information below is specific to using the No Surprises Act Good Faith Estimate & Consent Disclaimer for Health Care Goods and Services template within SimplePractice. It’s the responsibility of each respective provider to ensure their Good Faith Estimates and Consent Disclaimers are in compliance with local, state, and federal guidelines.
The Good Faith Estimate provision of the No Surprises Act is designed to give clients an estimate of how much they’ll be charged for the healthcare services they’ll be receiving, prior to their appointment. You can provide a good faith estimate to each of your clients.
Note: The good faith estimate is available for all subscription plans.
We'll cover:
- Requirements for providers
- Creating a good faith estimate
- Editing, printing, and downloading a good faith estimate
- Sharing a good faith estimate
- Additional resources
For answers to frequently asked questions about the good faith estimate, see Good faith estimate FAQs.
Requirements for providers
As of January 1, 2022, this legislation applies to all healthcare providers and facilities operating under the scope of a state-issued license or certification. You’re required to share a specific consent document in addition to a Good Faith Billing Estimate, prior to beginning care.
State-licensed or certified healthcare providers are required to provide a good faith estimate of charges to every new and continuing client who’s either uninsured, or isn’t planning to submit a claim to their insurance for the services they’re seeking. You’re also required to inform every uninsured or self-pay client of their right to receive a good faith estimate.
Note: We recommend asking each client whether they have insurance and intend to use it to cover the services that they seek. If the answer to either question is no, they’ll need a good faith estimate prior to their appointment.
Providers are also required to highlight the No Surprises Act on their Professional Website. A link to more information about the No Surprises Act must be present, along with a statement informing clients that they’re entitled to a good faith estimate. To do this, see Adding legal notices to your Professional Website.
Creating a good faith estimate
Note: Only team members with billing access for the client are able to create and send this form. To learn more, see Clinician roles available for team members and Administrative roles available for team members.
Below are some tips on entering your information:
- Most information will be auto-populated with your clinical information and the client's information, though all applicable fields can be updated
- Diagnoses and disclaimer text can't be removed from the good faith estimate
- If there's no diagnosis yet, the diagnosis will appear as None
- Client email addresses, physical addresses, and phone numbers aren't required on the good faith estimate, though client names and birthdates are required
- Diagnoses and disclaimer text can't be removed from the good faith estimate
- Under Details for services and items, you can manually update the Expiration date of the good faith estimate, as well as the Service dates and the Quantity of services you estimate to provide
- You'll receive a notification 30 days before a good faith estimate’s expiration date
Note: Good faith estimate forms can only be created from the browser version of SimplePractice.
To generate a good faith estimate for a client:
- Navigate to the client’s Overview page
- Click New > Good faith estimate
- Fill out the information for the client, provider, and services
- Click Add service to add an additional service or Add product to select a product
- Products must be created in your account before they can be added to a good faith estimate
- Use the Notes field to add any additional comments
Tip: You can update the Quantity and Fee for any service or product, and the total amount will recalculate automatically.
- You can delete a service or product by clicking the trash icon
- You can reorder your services and products by clicking and dragging the 6 dots beside a row
- After filling out the good faith estimate, click Save
Note: You can make multiple good faith estimates for a client. However, the same good faith estimate can't be used for multiple clients.
If you’d prefer to use a customized version of the good faith estimate, you can customize our pre-built Good Faith Estimate for Health Care Items and Services template and send this as an other document. For more information, see:
- Using pre-built templates and your template library
- Creating a new template and accessing the template builder
Note: Customizing and using the pre-built Good Faith Estimate for Health Care Items and Services template is only available on our Essential and Plus plans.
The good faith estimate shouldn't be shared as an intake form. For more information, see Why can’t I create an intake form to share with clients?.
Editing, printing, and downloading a good faith estimate
After saving, you can access the Good Faith Estimate from the client's Overview page.
On the top right of the good faith estimate, you have the following options:
- Pencil icon: Edit the good faith estimate
- Printer icon: Print the good faith estimate
- Arrow icon: Download the good faith estimate
Note: You won't be able to edit good faith estimates that have been shared with the client. For more information, see Sharing a good faith estimate.
Sharing a good faith estimate
To share the good faith estimate, click Share when you're viewing the good faith estimate.
Note: The good faith estimate will be shared via the Client Portal for the client to sign. If the client doesn't have access, they'll be provided access when you share the good faith estimate.
After clicking Share, follow the steps to Continue to Email > Continue to Review > Share & Send Now.
Note: An introduction and disclaimer is included in the good faith estimate when shared with the client. For more information on this, see Does the good faith estimate include all legally required information and disclaimers?
Once the good faith estimate has been signed by the client, it can't be edited or deleted. If the good faith estimate hasn't been signed by them, you can delete it from the client's Files tab, then edit it. To do this, see Downloading, renaming, or deleting a form or document.
After deleting the unsigned good faith estimate, you can navigate back to the client’s Overview page and select the Good Faith Estimate to make any changes. For more information, see Editing, printing, and downloading a good faith estimate.
Additional resources
- Pollen:
- CAMFT (California Association of Marriage and Family Therapists):
- APA (American Psychological Association):
- CMS (Centers for Medicare & Medicaid Services):
You can also find a PDF version of both the consent document and the Good Faith Estimate from CMS.gov below. As an alternative, you can share this with your client outside of SimplePractice and upload this to their profile. For more information, see Uploading a new client file.