NO SURPRISE ACT

Under the No Surprises Act, you have the right to receive a Good Faith Estimate explaining the expected cost of your care.

Healthcare providers are required to provide you with this estimate if you are uninsured or not using insurance (private pay). This includes mental health services such as individual therapy, group counseling, workshops, and consultations.

You can request a Good Faith Estimate at any time, in writing or verbally.

What the Good Faith Estimate Includes:

• The total expected cost of services

• A breakdown of fees per session or service

• An estimate for 12 months of care, or a shorter duration based on your treatment plan

This is not a bill or a contract, and you are not required to commit to any services by receiving the estimate.

If You Receive a Bill That Is At Least $400 More Than the Estimate:
You may have the right to dispute the bill through the U.S. Department of Health & Human Services.

To learn more, visit www.cms.gov/nosurprises
or call (800) 985-3059.