No Surprises Act (NSA) Notice:

​

​

​

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost. This includes psychotherapy and counseling services. 

 

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of their bill for health care items and services before those items or services are provided. 

​

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

• A Good Faith Estimate is available in a written document and may be provided in writing or verbally upon request. Make sure your health care provider gives you a Good Faith Estimate for the total expected cost of any non-emergency items or services.

• If you have requested a Good Faith Estimate, make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate from that provider or facility, you can dispute the bill. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises, email FederalPPDRQuestions@cms.hhs.gov, or
  call 1-800-985-3059  

​