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Good faith estimates

Under the No Surprises Act, every uninsured or self-pay client must receive a written Good Faith Estimate (GFE) of expected charges — and you must tell clients they have the right to one. The estimate doubles as a signed record of an agreed rate, which makes it the natural place to document a sliding-scale fee.

In this guide, we'll cover:

When you must provide one​

  • After scheduling: within 1 business day if the first session is 3+ business days out; within 3 business days if it's 10+ business days out.
  • On request: within 3 business days — and any conversation about costs counts as a request.
  • Recurring care: one estimate can cover ongoing sessions (it states the frequency and expected number) for up to 12 months. After that, issue a new one.

Creating and sharing an estimate​

  1. Open the client's profile page, click + New, and choose Good Faith Estimate, then New Good Faith Estimate.

    The New menu on a client's profile with Good Faith Estimate highlighted

  2. Check the prefilled details — your provider info (NPI/TIN) and the client's current diagnosis come in automatically (the most recent diagnosis set on the chart, not their whole history). No diagnosis yet is fine: the estimate prints "None", which is compliant for new clients.

  3. Add your service(s). The fee prefills from the client's own rate — so a negotiated sliding-scale rate lands automatically — and you can adjust the fee and session count per row. Use Notes to record how a sliding-scale rate was agreed.

    The Good Faith Estimate builder with expiration and service dates, session frequency, diagnosis codes, services, notes, and the signature checkbox

  4. Decide who signs. With Request a signature in the portal ticked, a Who signs list appears: the client (in their own portal) and every contact on the chart who has an email. Tick each person who should be able to open and sign the estimate — nobody is ticked for you. A signature is optional under the law, but a signed copy is your record of the agreed fee.

    The Who signs list under the signature checkbox, listing the client and each contact with an email

  5. Click Share to portal. The estimate (numbered GFE-####) appears in the client's portal under Billing & Payments → Good Faith Estimates, where they can download and print it. If you requested a signature, it also appears in the Documents list of each person you ticked, ready to review and sign.

The required federal disclaimer text (dispute rights, "this is an estimate, not a contract", and so on) is added automatically and can't be edited — that language is mandated.

Revising an estimate​

  • Drafts are editable freely.
  • A shared but unsigned estimate can be revised: click Revise — the old estimate is withdrawn and your changes go out under a new GFE number.
  • A signed estimate is locked permanently. Create a new estimate when fees change.

Good to know​

  • Your published practice website automatically carries the required No Surprises Act notice in its footer.
  • Clients can dispute a bill that runs $400 or more above their estimate, within 120 days — keeping estimates realistic is the best protection.
  • Estimates are part of the clinical record and stay available from the client's Billing tab.