GOOD FAITH ESTIMATE (No Surprises Act)

Good Faith Estimate

Under the federal No Surprises Act, health care providers are required to provide a Good Faith Estimate of expected charges for services to clients who do not have insurance or who are choosing not to use their insurance benefits.

Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate explaining the expected cost of psychological services. This estimate outlines the anticipated charges for services such as therapy sessions or psychological evaluations.

The estimate is based on the information known at the time it is created and may change depending on the scope of services provided.

Requesting an Estimate

You may request a Good Faith Estimate before scheduling services or at any point during treatment. The estimate will include anticipated fees for services that may be provided.

Disputes

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through the process outlined by the U.S. Department of Health and Human Services.

Additional information about your rights under the No Surprises Act can be found at:

https://www.cms.gov/nosurprises