Good Faith Estimate Notice

Under the No Surprises Act, you have the right to receive a Good Faith Estimate of expected charges for mental health services if you are uninsured or choosing not to use insurance.

A Good Faith Estimate outlines anticipated costs for scheduled non-emergency services based on information known at the time it is prepared. It is not a contract and actual charges may vary due to clinical needs or changes to the treatment plan.

If you receive a bill that is $400 or more above your Good Faith Estimate, you may have the right to dispute the charges through the federal patient-provider dispute resolution process.

More information is available at www.cms.gov/nosurprises or by calling 1-800-985-3059.

To request a Good Faith Estimate, please contact Onward Counseling.