Good Faith Estimate

Maternal Wellness Services Good Faith Estimate

Under the No Surprises Act (H.R. 133) which went into effect January 1, 2022, all healthcare providers are required to notify clients who do not have insurance or who are not using insurance benefits an estimate of the bill for medical items and services.

The law requires that I inform you verbally and in writing of your federally protected rights to receive a notification when services are rendered by an out-of-network provider, whether or not a client is uninsured or if a client elects not to use their insurance.

I do not participate with any insurance plans. Therefore, I am an out-of-network provider.

You have a right to receive a Good Faith Estimate for the total expected cost of any non-emergency services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

You will receive a formal GFE of costs for services in the billing agreement.

As you may know, it is difficult to determine the length of treatment for mental health care and each client has the right to decide how long they would like to participate in mental health care. Therefore, the GFE you will receive will include a fee schedule for the services typically offered by my practice. As always, I will collaborate with you to determine how many sessions you may need.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

Per the No Surprises Act, 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/nosurprises or call 800-985-3059.