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Confidentiality: List

Good Faith Estimate

You have the right to receive a "Good Faith Estimate" explaining how much your counseling care will cost

Under Section 2799B-6 of the Public Health Service Act, healthcare providers need to give clients who do not 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, equipment, and counseling fees.

  • You have the right to receive your Good Faith Estimate in writing at least 1 business day before your scheduled healthcare 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.

Disclaimers

  • The information provided in the Good Faith Estimate is only an estimate.

  • The Good Faith Estimate is not a contract, and does not bind, obligate, or require any client to obtain healthcare services or items from the provider at any time.

  • The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. Additional charges may be incurred if complications or exceptional circumstances occur.

  • There are no federal provisions allowing clients to waive their right to a Good Faith Estimate at this time. Clients are required to acknowledge receipt and understanding of each new Good Faith Estimate in order to comply with federal law and continue with the provider.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059. Make sure to save a copy or picture of your Good Faith Estimate.

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