GOOD FAITH ESTIMATE NOTICE.

Under the No Surprises Act, you are entitled to a “Good Faith Estimate” detailing the expected costs of your medical and mental health care.

By law, health care providers must provide patients without insurance, or those not using insurance, with a written estimate of anticipated charges for medical services, including psychotherapy, before the appointment. This estimate outlines expected costs but is not a binding contract, and you are not required to proceed with the services. It is intended to help you understand and plan for potential expenses.

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

You may request a Good Faith Estimate from your health care provider or any other provider you select before scheduling a service.

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, visit www.cms.gov/nosurprises.