No Surprises Act/Good Faith Estimate

Notice to clients & prospective clients:

Effective January 1st, 2022 under the law, Section 2799B-6 of the Public Health Services Act, providers need to give clients who don’t have insurance or who are not using insurance, an estimate of the expected charges for health care including psychotherapy services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare, including therapy services.

• You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.

• If you receive a bill that is at least more than $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy of your Good Faith Estimate.

• For questions or more information about your right a Good Faith Estimate, or information on how to dispute a bill, see your estimate, or visit www.cms.gocv/NoSurprises.

This Good Faith Estimate works to show the cost of items and services that are reasonably expected for your health care. This estimate is based on what is known at the time of the estimate. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charge more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. To learn more and to get a form, go to www.cms.gov/nosurprises or call 1-800-985-3059.