Good Faith Estimate & Your Right to a No Surprises Act Disclosure

Your Right to a Good Faith Estimate

Under the federal No Surprises Act, health care providers are required to give patients who are uninsured or who are not using their insurance an estimate of expected charges for services, called a Good Faith Estimate, in writing.

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your therapy. The estimate is based on information known at the time the estimate was created and does not include any unknown or unexpected costs that may arise during treatment.

What This Estimate Includes

• The expected cost of individual therapy sessions at the current private-pay rate
• An estimate based on the anticipated frequency of sessions, discussed and agreed upon during your consultation or intake

Because the number of sessions needed varies by individual, your estimate reflects a projected range rather than a fixed total.

Your Rights

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, in writing, at least 1 business day before your appointment.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.
• You may ask your health care provider for a Good Faith Estimate before you schedule a service, or any time during treatment.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Questions About Your Estimate

If you have questions about your Good Faith Estimate or would like one provided before your first session, please reach out via the Contact page or during your free consultation.