You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.

Under the Consolidated Appropriations Act of 2021, the United States federal government requires health care providers to give patients who do not have insurance — or who choose not to use insurance for privacy reasons — an estimate of the bill for health care services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services that I offer. This includes related costs like add-on services, collateral encounters, psychological testing, court appearances, copy/postage fees, etc.
  • Effective January 1, 2022, — as a part of my routine intake process — you will begin receiving a Good Faith Estimate in writing at least 1 business day prior to your initial appointment. I may also provide additional or revised estimates as warranted at later times. You can also ask me, and any other provider you choose, for a Good Faith Estimate before you schedule any services.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute the bill.
  • Please, make sure to save a copy or picture of your Good Faith Estimates.

For general questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the U.S. Department of Health & Human Services at (800) 368-1019.