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No Surprises Act &
Good Faith Estimates

Your Right to Receive a Good Faith Estimate of Expected Charges

Under the No Surprises Act, health care providers are required to provide individuals who are uninsured or not using insurance with a Good Faith Estimate of the expected charges for medical and mental health services.

You have the right to:

  • Receive a written Good Faith Estimate of the expected total cost of non-emergency health care services, including psychotherapy and any other reasonably anticipated charges related to your care.

  • Request a Good Faith Estimate before scheduling a service or at any time before receiving services.

  • Receive your Good Faith Estimate in writing at least one business day before your scheduled service whenever required by law.

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 through the federal patient-provider dispute resolution process.

Keep a Copy

Be sure to save a copy of your Good Faith Estimate for your records.

For additional information about your rights under the No Surprises Act, visit https://www.cms.gov/nosurprises.

If you have questions about Good Faith Estimates or self-pay fees at Empathy House Counseling & Wellness, PLLC, please contact:

Empathy House Counseling & Wellness, PLLC

Pamela Henning, LCMHC, LCASA, NCC

Email: pamela@empathyhousecounseling.com

Website: https://www.empathyhousecounseling.com

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