Two people sitting across from each other. Only showing their hands. The one on the left is using a laptop and the one on the right has hands resting on a notebook.

GOOD FAITH ESTIMATE

Good Faith Estimate Notice

You have the right to receive a Good Faith Estimate explaining how much your medical or mental health care will cost.

Under federal law, healthcare providers are required to give patients who do not have insurance or who are not using insurance an estimate of the expected charges for medical services.

Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services.

This includes related costs such as:

Therapy sessions
Evaluations
Other psychological services

Requesting an Estimate

You can ask for a Good Faith Estimate before scheduling a service or at any time during treatment.

If you schedule services at least 3 business days in advance, you can request a written estimate of expected costs.

If Your Bill Is Higher Than Your Estimate

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

You may initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS).

Questions

For questions or to request a Good Faith Estimate, please contact:

Stillpoint Psychology, PLLC
dr.elizabeth.hadorn@stillpoint-psychology.com

You can also learn more at:

https://www.cms.gov/nosurprises