Good Faith Estimate Notice

Your Right to Receive a Good Faith Estimate

Under federal law, health care providers are required to provide clients who do not have insurance or who are not using insurance with an estimate of the expected charges for medical and mental health services.

You have the right to receive a Good Faith Estimate explaining how much your mental health care may cost.

Before you begin services, you may request a written Good Faith Estimate for the expected cost of therapy services, including psychotherapy sessions and any other reasonably expected services.

The Good Faith Estimate is based on information known at the time it is provided and does not include unexpected costs that may arise during treatment.

You may receive additional Good Faith Estimates if:

• Your treatment needs change

• The frequency or length of sessions changes

• Additional services are recommended

• Fees change over time

You can ask your provider for a Good Faith Estimate before scheduling a service or at any time during treatment.

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

For questions or more information about your right to a Good Faith Estimate, visit: https://www.cms.gov/nosurprises