The Good Faith Estimate is a concept that was introduced with the No Surprises Act, an act passed by Congress in late 2021 aimed to protect patients from surprise medical bills and to decrease billing disputes between healthcare providers and patients. The act requires healthcare providers (including mental health professionals) to provide a self-pay or uninsured client with an estimate of the expected cost of services/treatments for that client. As the client, you have the right to obtain a Good Faith Estimate and, using this estimate, dispute any eventual treatment bills that are over $400 more than the Estimate provided.

If your needs change during our time together that result in fee/billing changes, such as increased or decreased frequency of therapy services, increase in session time or provision of services, or regularly occurring consults with another healthcare provider, I will provide you with a new Good Faith Estimate reflecting these changes.

The Good Faith Estimate is not a bill and does not require any payment at the time the estimate is provided. Payment is only required after the services have been provided.

More information about your rights under the No Surprises Act and general information about the Good Faith Estimate can be found in the actual Good Faith Estimate that will be provided to you or at www.cms.gov/nosurprises or call HHS at (800) 985-3059.