No Surprises Act Notice

Notice Regarding Client Protections Against Surprise Billing

The No Surprises Act is a federal law designed to protect individuals from unexpected medical bills.

As a private-pay mental health practice, Intrasage Therapy LLC provides transparent information regarding fees and expected costs for services.

Clients who are not using insurance or who choose to self-pay have the right to receive a Good Faith Estimate of expected charges before receiving services.

Your Good Faith Estimate will include:

• The expected cost of psychotherapy services

• Session fees

• Other reasonably expected charges related to your care

Please note:

• A Good Faith Estimate is not a contract

• Actual treatment needs may change over time

• The estimate does not guarantee the exact final cost of services

If you believe you have been billed substantially more than your estimate, you may have the right to initiate a dispute resolution process.

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

Questions

If you have questions regarding fees, payment, or your Good Faith Estimate, please contact: [Intrasage Therapy LLC] [support@intrasagetherapy.com] [414-348-8432]