No Surprises Act

You Have the Right to a Good Faith Estimate

Under the No Surprises Act, health care providers must give clients who don't have insurance, or who are not using insurance, an estimate of the expected charges for medical items and services. This is called a Good Faith Estimate.

What This Means for You

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including counseling and assessments.
• We will give you a Good Faith Estimate in writing at least 1 business day before your scheduled service, or within 3 business days if you schedule 10 or more business days ahead.
• You can also ask for a Good Faith Estimate before you schedule a service.
• The estimate will list the expected services, their codes, and expected charges, and will note that additional services may be recommended as treatment continues.

If You Are Billed More Than Your Estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You must start the dispute process within 120 calendar days of the date on the original bill.

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the estimate. If it disagrees and agrees with us, you will have to pay the higher amount.

Using Insurance

If you use insurance, your plan's network and cost-sharing rules apply. Please review your coverage and ask our office for help understanding your benefits.

Questions and Resources

To ask for a Good Faith Estimate, contact our billing office at [phone] or [email]. Keep a copy of your Good Faith Estimate for your records.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-985-3059.