Good Faith Estimate

(No Surprises Act)

Under the No Surprises Act, you have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. If you are not using insurance or are choosing to pay out-of-pocket, you can request a written estimate of the expected cost of services before you begin treatment.

Your Good Faith Estimate will include:

The cost per session

An estimate of the total expected cost based on your treatment plan

You have the right to receive this estimate:

Before scheduling services

At any time during treatment upon request

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the charges.

For more information about your rights, visit www.cms.gov/nosurprises