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Good Faith Estimate

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 are required to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for all medical services, including psychotherapy services.

 

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

You can ask your health care provider for a Good Faith Estimate before you schedule a service. While it is not possible for a therapist to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided.

If you receive a bill that is $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 (800) 985-3059.