Dear client

In compliance with the No Surprises Act that goes into effect January 1, 2022, all healthcare providers are required to notify clients of their Federal rights and protections against “surprise billing.”

This Act requires that we notify you of your federally protected rights to receive a notification when servicesare rendered by an out-of-network provider, if a client is uninsured, or if a client elects not to use theirinsurance.

Additionally, we are required to provide you with a Good Faith Estimate of the cost of services. It is difficultto determine the true length of treatment for mental health care, and each client has a right to decide how long they would like to participate in mental health care. Therefore, attached you will find a fee schedule forthe services typically offered by your therapist, and we will collaborate with you on a regular basis todetermine how many sessions you may need.

 

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

GOOD FAITH ESTIMATE