Notice of the Right to receive a Good Faith Estimate of Expected Charges under the No Surprises Act

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

Under the law, health care providers need to give patients who don’t have insurance or who self pay for their services an estimate of the bills for medical items and services (including psychotherapy services). 

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

• Ensure your health care provider gives you a Good Faith Estimate in writing at least one business day before your services begin. You can also ask your health care provider and any other provider you choose for a Good Faith Estimate before you schedule an item or 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/ or call the U.S. Department of Health and Human Services (HHS) at 1-800-985-3059.