Good Faith Estimate Notice

Under the law and in accordance with the Federal No Surprises Act, as of January 1, 2022, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical items and services.

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

• You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

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

• Make sure to save a copy or picture of your Good Faith Estimate.

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For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call HHS at (800) 368-1019.