Good Faith Estimate

Under the No Surprises Act, you have the right to receive a Good Faith Estimate that outlines the expected costs of your mental health care if you are not using insurance or do not have insurance.

This estimate is intended to help you understand and plan for the financial aspect of treatment before you begin care. It includes projected charges for services such as initial evaluations, follow-up sessions, and any additional care you and I may agree upon as part of your treatment. Please be aware that while it is not possible for a provider to predict, with absolute certainty, how many sessions may be necessary or clinically appropriate, the notice will provide an estimate of the cost of services provided.

Key Points to Know:

• You are entitled to request a Good Faith Estimate at any time—even before scheduling your first appointment.

• The estimate is based on the services we reasonably expect to provide, but it may be updated if your treatment plan changes.

• If a bill is at least $400 more than the estimate, you have the right to dispute the charges through a federal dispute resolution process.

• Requesting or receiving a Good Faith Estimate will not compromise the quality of care provided to you nor obligate you to receive care from the provider.

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