Meeting

Good Faith Estimate Notice

Notice to Clients and Prospective Clients:

Pursuant to the No Surprises Act (HR133, Title 45 Section 149.610),

health care providers are required to give clients who do not have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. This law is to protect clients from any unexpected fees related to services rendered.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.

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.

For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit:

www.cms.gov/nosurprises.