No Surprises Act | Good Faith Estimate

You as the client have the right to request a "Good Faith Estimate" per the No Surprise Act. If you would like an estimate of your self pay services or out-of-network costs, you may request this from your clinician. Please note that this is an estimate of services and may be an under or over-estimate of the total costs. This estimate is to ensure that you are not receiving any surprise costs. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 368-1019.

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) 368-1019.