Good Faith Estimate

GOOD FAITH ESTIMATE

 

Good Faith Estimate Notice

Under the No Surprises Act, you have the right to receive a “Good Faith Estimate” explaining the expected cost of your healthcare services.

Your Right to a Good Faith Estimate

You have the right to receive a written estimate of expected charges for non-emergency services, including psychotherapy and psychiatric medication management.

This estimate will include:

• The expected cost of services
• Any additional reasonably anticipated charges

When You Will Receive an Estimate

You may request a Good Faith Estimate:

• Before scheduling services
• At any time during treatment

Estimate Accuracy

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

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.

Additional Information

For questions or to request a Good Faith Estimate, please contact our office.