Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” explaining how much your mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of services, including therapy, assessments, and intake fees, at least 1 business day before your appointment. You can also request this estimate before scheduling.

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

• Save a copy or photo of your Good Faith Estimate.

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