Right to a Good Faith Estimate Notice
December 31, 2021

As of January 1st, 2022, state licensed providers who are outside of your insurance network must provide all clients with a Good Faith Estimate as part of the No Surprise Act. A Good Faith Estimate provides an estimate of the cost of expected non-emergency healthcare services.

What does that mean?

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

This means that you can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. Providers are required to provide you with the estimate in writing, as well as review it with you verbally.

Make sure to save a copy or picture of your Good Faith Estimate. If you later receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

What can I expect from you?

We will provide you with a Good Faith Estimate annually for the estimated cost of services over the year to come. This estimate will be based on our current service fees and provide a cost range based on anticipated frequency and type of service. If there are any changes to frequency or type of service throughout the year that will significantly impact this initial Good Faith Estimate, we will provide you with an updated estimate.

Questions? Please do not hesitate to contact us!