Good Faith Estimate

As part of the No Surprises Act, you have the right to receive a Good Faith Estimate explaining how much your mental health care will cost.

If you are uninsured or choose not to use insurance, I will provide a written estimate of expected charges before services begin.

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

• You can ask for this estimate in writing before you schedule a service—or at any time.

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

For more information, visit www.cms.gov/nosurprises.