Good Faith Estimate

In order to comply with Section 2799B-6 of the Public Health Service Act, the following information is provided:

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 must give patients who do not have insurance, or who are not using insurance, an estimate of the expected charges for services, including counseling.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services. You can ask your provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Keep a copy or a picture of your Good Faith Estimate.

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