Good Faith Estimates for insured patients

Short answer: today the obligation covers uninsured and self-pay patients. Patients who have insurance but don't use it for your services count as self-pay, so many insured clients are covered after all.

Who counts as self-pay

The federal rule (45 CFR 149.610) defines an uninsured or self-pay individual as someone who either:

• has no coverage for the service, or
• has coverage, but does not seek to have a claim for the service submitted to their plan.

So an insured client who decides to pay you directly and not involve their plan is self-pay, and you must offer a Good Faith Estimate.

What about out-of-network clients who submit superbills?

This is the grey area for therapists. A client who pays you and then sends a superbill to their insurer is, arguably, seeking reimbursement through the plan. The rule doesn't address this case directly.

Because an estimate costs you a few minutes and protects you if there is a dispute later, many practices simply give a Good Faith Estimate to every client who pays them directly, whatever the client plans to do with insurance.

Insured patients using their plan: the AEOB rule

The No Surprises Act also envisions estimates for patients who do use their insurance: the provider sends a Good Faith Estimate to the health plan, and the plan sends the patient an Advanced Explanation of Benefits (AEOB) showing what it will pay.

That part has not taken effect. The Department of Health and Human Services deferred enforcement until it issues further rules, and as of October 2026 no enforcement date has been set. Until then, providers are not required to send estimates to health plans. Check cms.gov/nosurprises for updates.

A practical checklist

1. At scheduling, ask every new client whether they will use their insurance through you.
2. If not, or if they pay you directly, give them a Good Faith Estimate within the deadline (1 or 3 business days, depending on how far ahead you schedule).
3. For weekly therapy, issue one estimate covering up to 12 months, and a new one if the plan changes.
4. Keep a copy: estimates are part of the client's record.

Questions