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 clients who don’t have insurance, or who are not using insurance, an estimate of the expected charges for services.

• You have the right to receive a Good Faith Estimate of the total expected cost of any non-emergency services. This includes related costs such as the diagnostic evaluation and psychotherapy sessions.

• Make sure your provider gives you a Good Faith Estimate in writing at least one business day before your service. You can also ask 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.

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

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