Good
Faith
Estimate

Notice of Your Right to Receive a Good Faith Estimate of Expected Charges 

Under the federal law called the No Surprises Act, you have the right to receive a “Good Faith Estimate” of the cost of your health care services if you do not have insurance or you are not using insurance for your care.

You have the right to receive a Good Faith Estimate in writing for the total expected cost of any non-emergency services, including psychotherapy services, before those services are provided. 

You can ask your therapist (and any other provider you choose) for a Good Faith Estimate before you schedule a service.  

If you receive a bill that is $400 or more above the Good Faith Estimate provided, you may have the right to dispute the bill.

The Good Faith Estimate is not a contract and does not require you to obtain services from the provider who gave the estimate.

If you don’t have insurance or are choosing not to use insurance for these services, please ask your provider for a Good Faith Estimate of the cost.

For more information about your rights under the No Surprises Act, visit www.cms.gov/nosurprises or call 1-800-985-3059