Good Faith Estimate

Under the No Surprises Act, health care providers are required to provide individuals who are not using insurance with a Good Faith Estimate of expected charges for health care services.

You have the right to receive a Good Faith Estimate explaining the expected cost of your mental health care before you begin services.

The Good Faith Estimate outlines the anticipated costs of services based on the information available at the time it is provided. Because therapy is individualized, the total cost of treatment may vary depending on your specific needs, goals, and the course of treatment.

You have the right to:

• Receive a Good Faith Estimate before scheduled services.

• Ask questions about the estimate or the expected cost of treatment.

• Keep a copy of your Good Faith Estimate for your records.

If you receive a bill that is substantially higher than your Good Faith Estimate, you may have the right to dispute the charges through the federal patient-provider dispute resolution process.

For more information about your rights under the No Surprises Act, please visit www.cms.gov/nosurprises or call 1-800-985-3059.

If you have questions about fees or the cost of treatment, please feel free to discuss them with me before beginning services.