Good Faith Estimate Notice 

Under Section 2799B-6 of the Public Health Service Act, health care providers and facilities must inform individuals who are not enrolled in a health plan, are not covered by a Federal health care program, or are not seeking to file a claim with their health plan, of their right to receive a “Good Faith Estimate” of expected charges, both orally and in writing.

Your Right to a Good Faith Estimate

As a client, you have the right to receive a “Good Faith Estimate” detailing the expected costs of non-emergency healthcare services. This includes services provided by mental health professionals like myself.

  • Who Should Receive a Good Faith Estimate: You are entitled to a Good Faith Estimate if you are uninsured or if you choose not to use your insurance for a particular service.

  • What the Estimate Includes: The Good Faith Estimate will cover the total expected cost of any non-emergency services. This includes related costs like therapy sessions, medical tests, prescription drugs, equipment, and any applicable fees.

  • When You Should Receive the Estimate: You should receive a Good Faith Estimate in writing at least 1 business day before your scheduled service. You can also request a Good Faith Estimate from me or any other provider you choose before scheduling an appointment.

  • Disputing Charges: If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the charges.

  • Keeping Records: Be sure to save a copy or take a picture of your Good Faith Estimate for your records.

For more information about your rights under the No Surprises Act, visit www.cms.gov/nosurprises.