This Good Faith Estimate notice is provided in compliance with the federal No Surprises Act (effective January 1, 2022).

Your Right to a Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical and 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 medical services, including psychotherapy.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including psychotherapy.
• Make sure your health-care provider gives you a Good Faith Estimate in writing at least 1 business day before your service. You can also 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.
• Make sure to save a copy or picture of your Good Faith Estimate.

How to Request Your Estimate

To request a Good Faith Estimate before scheduling services, please contact us through our contact page and mention “Good Faith Estimate Request.” We will respond in writing within 1–3 business days.

For More Information

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