Good Faith Estimate

Under the No Surprises Act, health care providers are required to provide clients who are uninsured or who choose not to use their insurance benefits with a Good Faith Estimate of expected charges for services.

If you are using your in network benefits through Optum, UnitedHealthcare, or Oxford, this requirement does not apply. If you are uninsured or receiving services on a self pay or out of network basis, you have the right to receive a written Good Faith Estimate prior to beginning services or upon request.

A Good Faith Estimate outlines the reasonably expected costs of psychotherapy services based on information known at the time the estimate is created. Because psychotherapy is individualized, it is not possible to determine in advance the exact number of sessions that may be needed. The total cost of services will depend on session frequency, duration, and your individual treatment needs.

If you receive a Good Faith Estimate and are billed $400 or more above the estimated charges, you have the right to initiate a federal dispute resolution process.

Good Faith Estimates are provided in accordance with federal law and are issued through the practice’s electronic health record system.

For additional information about your rights under the No Surprises Act, please visit www.cms.gov/nosurprises or call 800 368 1019.