Good Faith Estimate

Good Faith Estimate Notice You have the right to receive a Good Faith Estimate that outlines the expected costs of your mental health care. Under federal law, health care providers are required to provide a cost estimate for clients who are uninsured or who choose not to use insurance. What You Need to Know: You are entitled to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including fees related to therapy, evaluations, and any associated items (such as medical tests, prescription medications, or equipment, if applicable). Your provider must give you this estimate in writing at least 1 business day before your scheduled service. You may also request an estimate from any provider before scheduling. If you receive a bill that is $400 or more above the Good Faith Estimate, you have the right to dispute the charge. Be sure to keep a copy of your Good Faith Estimate for your records. Dispute Resolution Process: If you are billed significantly more than the estimated cost, you can initiate a dispute resolution process through the U.S. Department of Health and Human Services (HHS). You must begin this process within 120 days of the original bill date. There is a $25 fee to file. If the decision is in your favor, you’ll only be required to pay the amount listed in the Good Faith Estimate. If not, you may be responsible for the higher amount. For more information or to learn about your rights under the No Surprises Act, visit www.cms.gov/nosurprises or call 1-800-985-3059