Your Rights as a Patient
Good Faith Estimate
Under the No Surprises Act, you have the right to receive a Good Faith Estimate of expected costs before your care begins. We are committed to transparency so you can make informed decisions about your mental health care.
What is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written notice that outlines the expected cost of your mental health services. It is not a bill — it is an estimate provided to you before your care begins so you understand what you may owe.
Under the No Surprises Act, which went into effect January 1, 2022, healthcare providers are required to give uninsured (or self-pay) patients a Good Faith Estimate of costs for services upon request or when scheduling care.
Who is this for?
- Patients who are uninsured
- Patients who choose not to use their insurance for services
- Patients who are paying out of pocket for any reason
What your estimate will include
Provider information
The name, address, and contact information of the provider delivering your care.
Service description
A clear description of the services expected to be provided, including the type and frequency of sessions.
Expected costs
An itemized list of expected charges for each service, including session fees and any associated costs.
Diagnosis and service codes
The diagnosis codes (ICD-10) and service codes (CPT) that will be used for your care.
Your rights under the No Surprises Act
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises.
Request a Good Faith Estimate
You may request a Good Faith Estimate at any time before scheduling your first appointment or at the start of a new service. Please reach out and I will provide your written estimate within the required timeframe.