Good Faith Estimate Notice
Under the No Surprises Act, health care providers are required to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency 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 within 120 days of the bill date. Make sure to save a copy of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.