Good Faith
Estimate Notice

Your Right to a Good Faith Estimate

Under the No Surprises Act, health care providers are required to provide individuals who are uninsured or who choose not to use their insurance with a Good Faith Estimate of the expected cost of health care services.

You have the right to receive a Good Faith Estimate before scheduling a service or at any time upon request. The estimate is intended to provide an overview of the expected charges for the services you may receive.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

A Good Faith Estimate does not include unexpected costs that may arise due to unforeseen circumstances or changes to your treatment needs. Additional services that become clinically appropriate may result in additional charges, which will be discussed with you whenever possible.

You may request a Good Faith Estimate before your first appointment or at any time during the course of treatment.

For additional information about your rights under the No Surprises Act, please visit the Centers for Medicare & Medicaid Services (CMS):
https://www.cms.gov/medical-bill-rights

If you have questions about your Good Faith Estimate or would like to request one, please contact Rooted Love Counseling.