Good Faith Estimate

Passed in January 2022, the No Surprise Act required all healthcare providers and facilities to provide an estimate of the cost of services to uninsured or self-paying clients clients/patients. The purpose is to prevent private pay consumers from receiving “surprise” medical bills.

The Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs. The estimate is based on information known at the time the estimate was created. It does not include any unknown or unexpected costs that may arise during treatment, including fees for late-cancellations or no-shows. The frequency and total number of sessions may vary based on clinical need and therapeutic progress; participation in therapy does not guarantee a specific number of sessions.

You are entitled to a Good Faith Estimate within the following timeframes:

• If the first appointment is scheduled 3-9 business days in advance, the estimate must be provided within 1 business day after scheduling the appointment.

• If the first appointment is scheduled 10 or more business days in advance, the estimate must be sent within 3 business days after scheduling the appointment.

You have the right to dispute a bill that is substantially above (>$400) the amount shown on the estimate. There is a $25 fee to use the dispute process. 

For more information, visit www.cms.gov/nosurprises or call 1-800-985-3059.

**The Good Faith Estimate is valid for 12 months and it is NOT a contract. **