Good Faith Estimate Notice

In accordance with the Federal No Surprises Act, you have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services, in writing at least one business day before your medical or psychotherapy service.

  • You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

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

  • Make sure to save a copy or picture of your Good Faith Estimate.

 Contact

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (800) 985-3059.

If you have any other questions about this Good Faith Estimate Notice, You can contact Us: