Good Faith Estimate

Overview

Your Rights

What is a “Good Faith Estimate?”

A Good Faith Estimate (GFE) is a written document that provides you with a clear, upfront estimate of the expected costs for services that will be provided at our practice. It includes our rates for different services, including session length, billing practices, payment methods, and any other charges you might incur for treatment. The purpose of a GFE is to give you transparency regarding the financial aspects of your care before you receive treatment, or at any time during the course of your treatment.

Under the No Surprises Act, healthcare providers (including psychotherapists) are required to offer a GFE to clients who do not have insurance or are paying out-of-pocket; ensuring that they are fully informed of their potential costs prior to starting or continuing therapy.

The No Surprises Act is a federal law that went into effect on January 1, 2022, and is aimed at protecting consumers from unexpected and often high medical bills. This includes psychotherapy services.

  • You have the right to receive a Good Faith Estimate explaining how much your health care will cost you.

  • You have the right to a Good Faith Estimate both orally and in writing.

  • You can request a Good Faith Estimate before any service is rendered or at anytime during the course of your treatment.

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

  • The Good Faith Estimate does not include any unknown or unexpected costs (e.g.: emergency services) that may arise during treatment. If this happens, federal law allows you to dispute (appeal) the bill.

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

  • You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

  • You may start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

  • Please save a copy or picture of your Good Faith Estimate.

To receive more information about your rights to a Good Faith Estimate, please visit www.cms.gov/nosurprises.

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