Forms

Your Right to a Good Faith Estimate

 

Under the law, healthcare providers are required to provide clients who do not have insurance or who are not using insurance with an estimate of expected charges for services.

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

 

What is a Good Faith Estimate?

 

A Good Faith Estimate shows the costs of items and services that are reasonably expected for your mental health care needs for an item or service. The estimate is based on information known at the time the estimate is created.

 

When will you receive a Good Faith Estimate?

 

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services upon request or when scheduling services.

If you schedule a service at least 3 business days in advance, you can ask for a Good Faith Estimate in writing.

 

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

 

For questions or more information

 

If you have questions about your right to a Good Faith Estimate, you may visit:
www.cms.gov/nosurprises

 

You may also contact our office directly to request a Good Faith Estimate prior to beginning services.