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Good Faith Estimate

 

The No Surprises Act, which went into effect on January 1, 2022, requires health care providers to give patients a Good Faith Estimate of the cost of care.

 

Under this law, providers must give an estimate to patients who do not have insurance or are not using insurance for services. This estimate reflects the expected cost of services based on information available at the time it is created.

 

Please note that the total cost of services may change depending on the number of sessions you attend. Services outside of standard therapy or evaluation may involve additional fees.

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Your rights under the No Surprises Act

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.

  • I will provide a written Good Faith Estimate at least 3 business days before your scheduled service, or within 1 business day if your appointment is scheduled on short notice.

  • You may also request a Good Faith Estimate before scheduling services.

  • If you receive a bill that is $400 or more above your Good Faith Estimate, you have the right to dispute the bill.

  • Please save a copy or photo of your Good Faith Estimate for your records.

 

For more information about your rights under the No Surprises Act, visit

www.cms.gov/nosurprises or call 1-877-696-6775.

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