Good Faith Estimate Notice

Under the No Surprises Act, you have the right to receive a Good Faith Estimate (GFE) explaining the expected cost of your mental health care.

• A Good Faith Estimate is provided if you are not using insurance or are paying out-of-pocket for services.

• The estimate will include the expected costs of services we anticipate providing.

• You will receive your Good Faith Estimate in writing before your first appointment and at any time upon request.

• This is not a bill; actual costs may vary depending on your needs, progress in therapy, and any changes to your treatment plan.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the charge.

For more information about your rights, please visit www.cms.gov/nosurprises.