Good Faith Estimate
As of January 1, 2022, under the No Surprises Act, you have the right to receive a Good Faith Estimate (GFE) of the expected cost of your mental health care.
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Who is entitled to a Good Faith Estimate?
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Clients who are uninsured.
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Clients who are choosing not to use their insurance (self-pay).​
What does the estimate include?
The Good Faith Estimate will outline:
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Your name and the date of the estimate.
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A description of the services you are expected to receive.
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Diagnosis and service codes (if known/applicable).
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The provider’s name, credentials, and identifying information.
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The estimated cost of each service and the total projected cost.
When will you receive it?
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If you schedule services at least 10 business days in advance → you will receive your estimate within 3 business days.
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If you schedule services at least 3 business days in advance → you will receive your estimate within 1 business day.
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If you request a Good Faith Estimate without scheduling services → you will receive it within 3 business days of the request.
Important things to know
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The Good Faith Estimate is only an estimate. Actual services, frequency, and costs may change depending on your needs.
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You are not required to accept or continue with services listed in the estimate.
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If you receive a bill that is $400 or more above the Good Faith Estimate, you have the right to dispute the charge through the federal dispute resolution process.
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You should keep a copy of your Good Faith Estimate for your records.
How to request a Good Faith Estimate
You may request a Good Faith Estimate at any time before or during your work with me. Written requests can be sent to me by email.
More information
For more details about your rights under federal law, visit: www.cms.gov/nosurprises.
For New York State information on surprise billing protections, visit: NY Department of Financial Services – Surprise Bills.