The No Surprises Health Service Act:
Good Faith Estimate Notice

In compliance with the No Surprises Act that went into effect January 1, 2022, healthcare providers are required to provide clients who do not have insurance or who choose not to use their insurance with a Good Faith Estimate of the cost of services.

Because it is not possible to predict how many or the length of the sessions you will need or choose to receive, the estimate contains a fee schedule for various scenarios relevant to your treatment.

In accordance with the law:

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including counseling 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.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit cms.gov/priorities/legislation/no-surprises-act.