Good Faith Estimate

OVERVIEW FOR CLIENTS WITHOUT INSURANCE OR CHOOSING NOT TO USE THEIR INSURANCE

Beginning January 1, 2022, you have the right to receive a Good Faith Estimate (hereinafter referred to as “the estimate” or “estimate“) explaining how much your medical care will cost.

Under the Under Section 2799B-6 of the Public Health Service Act, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

You have the right to receive an estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. If you receive a bill that is at least $400 more than your estimate, you can contact us, or choose dispute the bill. Refer to your estimate documents for additional information. Make sure to save a copy or picture of your estimate.

YOUR GOOD FAITH ESTIMATE

Since our counseling services are provided in a series of recurring therapy appointments, your estimate will cover a term that begins on the date of your first appointment after January 1, 2022. If anything changes during the course of your treatment, we will provide you with an updated estimate. (Updated estimates will automatically void any previously issued estimates). Your estimate does not require you to receive services from us.

EXAMPLES

Here are two examples of what your estimate might look like:

Example 1

 I expect that my care of you will require continued weekly therapy sessions for the next six months at $x per session.

Or if the future course of treatment is less certain, an estimate might look like this:

Example 2

Depending on the progress we make, I expect that you will need 10 more sessions at $x per session and a frequency of ________.

HOW TO GET YOUR ESTIMATE

Your estimate is always accessible from your account on the secure client portal and will first be made available starting at your first appointment time. You can also ask for a copy of your estimate after we review it at your first scheduled appointment time.

DISPUTE AND RESOLUTION

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059.