Good Faith Estimate

ABOUT YOUR RIGHT TO RECEIVE A GOOD FAITH
ESTIMATE OF EXPECTED CHARGES

Under the law, patients who are not using insurance or who do not have insurance are entitled to an estimate of the bill for medical items and services, including psychotherapy.

This estimate is called a "Good Faith Estimate" and explains how much your therapy services will cost, as I am not in network with any health insurance plans. Here are a few key things you should know about your Good Faith Estimate:

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • You may ensure that I give you a Good Faith Estimate in writing at least 3 business days before your Therapy services or item. You can also ask me for a Good Faith Estimate prior to scheduling.
  • If you receive a bill that is $400 more than your Good Faith Estimate, you can dispute the bill.
  • It's recommended that you save a copy of your Good Faith Estimate for your records.

For further information, visit www.cms.gov/nosurprises or call 800-985-3059.