Good Faith Estimate Notice & Your Rights

This is a federally required disclosure under the No Surprises Act, effective Jan 1, 2022.

• If you are uninsured or choose not to use your insurance, you have the right to receive a “Good Faith Estimate” (GFE) explaining how much your care is expected to cost.

• Under the law, healthcare providers must 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 GFE for the total expected cost of any non-emergency items or services.

• Your provider should give you a GFE in writing at least 1 business day before your service, through your secure client portal. You will be requested to electronically sign the document prior to your session.

• You can also ask your provider, and any other provider you choose, for a GFE before you schedule an item or service.

• If you receive a bill that is at least $400 more than your GFE, you can dispute the bill.

• For questions or more information about your right to a Good Faith Estimate, visit: www.cms.gov/nosurprises.