Good Faith Estimate Disclosure
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
A Good Faith Estimate (GFE) is a document designed to help you plan financially for therapy services. It provides an estimate of the expected costs of care based on the information available at the time it is created. This is not a bill, contract, or guarantee of total costs. Actual costs may change depending on your needs, frequency of sessions, scheduling changes, insurance status, or changes in treatment over time.
The purpose of the Good Faith Estimate is to support transparency and help you make informed decisions about the financial aspects of care. You are not obligated to complete the full estimated amount of services listed, and treatment plans may evolve collaboratively throughout the therapy process.
Under federal law, clients who are uninsured or not using insurance have the right to receive a Good Faith Estimate for anticipated healthcare costs. If your final charges are substantially higher than the estimate, you may have the right to dispute the bill.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or 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.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.
Aviso de estimación de Buena Fe
Tiene derecho a recibir un “Estimado de buena fe” que explique cuánto costará su atención médica y de salud mental.
Según la ley, los proveedores de atención médica deben proporcionar a los pacientes que no tienen seguro o que no usan seguro una estimación de los cargos esperados por los servicios médicos, incluidos los servicios de psicoterapia.
Tiene derecho a recibir una estimación de buena fe por el costo total esperado de cualquier servicio de atención médica que no sea de emergencia, incluidos los servicios de psicoterapia.
Puede pedirle a su proveedor de atención médica, y a cualquier otro proveedor que elija, un estimado de buena fe antes de programar un servicio.
Si recibe una factura que es al menos $ 400 más que su Estimación de buena fe, puede disputar la factura. Asegúrese de guardar una copia o una imagen de su Estimación de buena fe.
Si tiene preguntas o necesita más información sobre su derecho a una estimación de buena fe, visite www.cms.gov/nosurprises.
