Good Faith Estimate

ABOUT YOUR RIGHT TO RECEIVE A GOOD FAITH ESTIMATE
OF EXPECTED CHARGES

Under the No Surprises Act, health care providers are required to give clients who don’t have insurance or who are choosing not to use insurance an estimate of the expected cost of services.

This estimate is called a Good Faith Estimate and outlines the anticipated cost of your therapy services.

• You have the right to receive a Good Faith Estimate for the total expected cost of non-emergency services. You may request this estimate before scheduling or at any time during treatment, and I will provide it in writing at least 3 business days before your scheduled service when applicable.

• If you receive a bill that is $400 or more above your Good Faith Estimate, you have the right to dispute the bill.

• It's recommended that you save a copy of your Good Faith Estimate for your records.

For more information about your right to a Good Faith Estimate, you can visit www.cms.gov/nosurprises.