No Surprises Act Notice

Your Right to a Good Faith Estimate

By law, all health care providers need to give clients without insurance or those choosing not to use their insurance an estimate of the bill for services. You have the right to receive a Good Faith Estimate (GFE) for the total expected cost of any non-emergency items or services, including mental health services like professional counseling.

Your health care provider is required to give you a GFE in writing within 1 business day for services scheduled at least 3 days in advance, or within 3 business days for services scheduled 10+ days ahead. You can also ask your health care provider, and any other provider you choose, for a GFE before you schedule a service.

If you receive a bill that is at least $400 more than your GFE, you can dispute the bill. Make sure to save a copy or picture of your GFE.

For questions or more information about your right to a GFE, visit www.cms.gov/nosurprises or call 1-877-696-6775 or 1-800-985-3059.