What a Good Faith Estimate is
A Good Faith Estimate is an estimate of expected charges for items and services that may be provided as part of your care. It is not a bill. The GFE gives you upfront, written information about what care is likely to cost so you can decide before scheduling.
When this applies
This applies if you do not have insurance, or if you choose not to use insurance for services.
Disputing a bill
If you receive a bill that is at least $400 more than the expected charges listed in your Good Faith Estimate from that provider or facility, you may be able to dispute the bill through the federal patient-provider dispute resolution process.
Learn more: CMS — Dispute a medical bill.
Requesting an estimate
If you have questions about fees or would like to request a Good Faith Estimate, please use the appointment request form. Include "Good Faith Estimate" in your message so I can route your request appropriately.
Legal basis
This notice is provided under the No Surprises Act (42 U.S.C. § 300gg-136) and implementing regulations at 45 C.F.R. § 149.610 (published in 86 Fed. Reg. 55980, Oct. 7, 2021). It applies to uninsured and self-pay clients of behavioral health services.