Good Faith Estimate

Under federal law (the No Surprises Act), you have the right to receive a "Good Faith Estimate" clearly outlining the expected cost of your non-emergency therapy services.

This applies to you if:

• You don't have health insurance, or

• You plan to pay for therapy yourself (out-of-network) and won't be filing an insurance claim.

How to get your Estimate:

You can request a Good Faith Estimate at any time. I will provide it to you in writing before your first session or within 1-3 business days of your request.

What your estimate will include:
It will detail my fees for our sessions together and provide an estimate of the total cost based on our anticipated work together.

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

Please save a copy of your estimate for your records. For more information about your rights, you can visit the official CMS website at www.cms.gov/nosurprisesor call 1-800-985-3059.