Good Faith Estimate Notice

As part of our client-therapist relationship, and in compliance with a federal law, "The No Surprises Act”, I am providing you with this notice.

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.

Under the law, health care providers are required to give patients who are out of network, don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. I will provide you a Good Faith Estimate in advance of your appointment if you will be paying out of pocket for services. 

Please be advised you can ask any health care provider for a Good Faith Estimate before you schedule 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.