Good Faith Estimate of Costs

In late 2021, Congress passed a law which requires healthcare practitioners to provide a "good faith estimate" of expected costs of your healthcare should you opt out of insurance coverage or should you not have insurance. There are also new laws that help minimize impact of non-network services being offered as a "surprise" as part of a hospital stay - for this reason, the law is called the "No Surprises Act." This page contains everything you need to know about the No Surprises Act and also provides a Good Faith Estimate of my services.

Patient Protections Against Surprise Billing (No Surprises Act)

Effective January 1, 2022

When you get emergency care or are treated by an out-of-network provider at an in-network facility, you are protected from surprise billing (also called “balance billing”).

What is “balance billing”?

When you see a doctor or other health-care provider, you may owe certain out-of-pocket costs—like a copay, coinsurance, or deductible.
If you see an out-of-network provider, you might have additional costs or be billed the difference between what your health plan pays and the full charge—this is called “balance billing.”

The No Surprises Act protects you from balance billing in certain circumstances.

You are protected from balance billing:

Emergency Services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most you can be billed is your plan’s in-network cost-sharing amount. You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and waive your protections.

Non-Emergency Services at an In-Network Facility
When you get services from an in-network hospital or ambulatory surgical center, certain providers there (for example, anesthesiologists, radiologists, pathologists, or assistant surgeons) may be out of network. In these cases, you can’t be balance billed for those services unless you have given written consent to be billed out of network.

In the case of Dr. Steadman's practice at Chattanooga Peds, Dr. Steadman is NOT in all the same insurance networks as the medical providers in the office. You should not assume that just because your insurance covers medical visits here, it will also cover visits with Dr. Steadman. We try to always inform you if you have insurance that Dr. Steadman is not in network with. In these cases, if you still want to work with Dr. Steadman, you can choose to pay out-of-pocket fees, which are outlined in detail in Dr. Steadman's policies and procedures documentation. Under these legal definitions, our office is not a "facility." We are classified more like independent providers.

Tennessee-specific note:
Tennessee law offers similar protections for emergency and facility-based care under Tenn. Code Ann. § 56-7-3701 et seq. These state protections work together with federal law to prevent unexpected out-of-network charges.

When you’re not protected from balance billing:

You may choose to see an out-of-network provider and agree in writing to pay the full charge. In this case, you could be billed more than your plan would pay in-network. Dr. Steadman's fees are listed on documentation you sign at your first appointment.

Good Faith Estimates for Uninsured or Self-Pay Clients

If you don’t have insurance or are not using insurance, you have the right to receive a Good Faith Estimate explaining how much your care will cost.

You can ask for a Good Faith Estimate before scheduling any service.
If you receive a bill that is $400 or more than your estimate, you may dispute the charge.
Keep a copy or picture of your Good Faith Estimate.

For questions or to request an estimate, contact our billing department at (423)825-4040.

In most cases, this applies to testing only, as Dr. Steadman does not routinely accept self-pay therapy clients. You should be provided with a Good Faith Estimate of out-of-pocket expenses for testing. However, again, full testing costs are listed in Dr. Steadman's policies and procedures document, which you receive and sign at your first appointment. By signing this document, you are agreeing that you have received a complete copy of estimated expenses for Dr. Steadman's services.

You may also visit www.cms.gov/nosurprises for more information about your rights.

If you believe you’ve been wrongly billed

First, call our billing office at (423)825-4040. If things do not feel resolved then,

You may contact:

Federal Help Line: 1-800-985-3059
Tennessee Department of Commerce & Insurance
Consumer Insurance Services
500 James Robertson Parkway, Nashville, TN 37243
Phone: (615) 741-2218 or 1-800-342-4029
Website: https://www.tn.gov/commerce

Sample Good Faith Estimate

This form is the Good Faith Estimate (GFE) I use in my practice. It contains an estimate of expected costs for professional services. A full description of expected costs can be found in my Forms page.

Jason L. Steadman, Psy.D. ABPP

Chattanooga Pediatrics

3328 Jenkins Road, Suite 200

Chattanooga, TN 37421

(423)825-4040

Date of Good Faith Estimate __________________. This estimate is for psychotherapy services for 1 year from the date of this estimate, unless we send you an updated estimate sooner.

The estimate below is based on most likely expected costs based on the clinical information present at the time of the estimate. For new patients, this estimate includes an intake/initial evaluation, after which we will discuss more formally the expected frequency of sessions. For ongoing patients, you can expect to continue the same frequency as usual, unless we discuss otherwise. Psychotherapy services are difficult to predict at times with regard to the duration and frequency of services. This estimate is based on what I usually expect for patients like you, but of course things can change and we may need to see each other more frequently or less frequently than what we estimate in this agreement. Most often, I see patients every 1 to 2 weeks, though sometimes less frequently. At an out-of-pocket cost (without insurance) of $120 per session, this means that you can expect the total annual cost of 1 year of psychotherapy to range between $3120-$6240. Most patients do not receive weekly services for a full year though, and many can complete a course of therapy in 10-15 sessions, which would equate to $1200-$1800 out-of-pocket costs total.

Details of the estimate

The following is a detailed list of expected charges for psychological services for ___[patient name]____ from _____[anticipated date range]___. The estimated costs are valid for 12 months from the date of this GFE, unless you are given an updated estimate.

Initial evaluation (CPT Code 90791) = $200. This is a one time cost for the first appointment only.
45-60 minute therapy session (90834 or 90837) = $120. This is cost per session. I anticipate having up to _________ sessions, for a total cost of $__________.
Testing (these fees are covered in more detail elsewhere on my website):