No Surprises Act

Good Faith Estimate

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You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. 

 

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

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• Current Clients (who do not have insurance or who are not using insurance benefits): have the right to receive a “Good Faith Estimate” outlining an estimate of the expected charges for psychotherapy services. 

 

• New Clients (those who do not have insurance or who are not using insurance benefits): have the right to ask for a Good Faith Estimate before the first scheduled session. 

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Please note that the Good Faith Estimate only provides an estimate based on the costs of items and services that are reasonably expected for services provided by Flor Y Siendo Therapy and Wellness. The estimate is based on information known at the time the estimate is created. It does not take into account any reimbursement that you may receive as a result of out-of-network benefits. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if additional services are needed during special circumstances.

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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.

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