Good Faith Estimate for Mental Health Services Notice

Under the law and in accordance with the Federal No Surprises Act, as of 1/1/2022, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes psychotherapy services.

• You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• 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.

For questions or more information about your right to a Good Faith Estimate, visit **www.cms.gov/nosurprises **or call HHS at (800) 368-1019.