Good Faith Estimate
Notice of Your Right to a Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.
Under the law, healthcare providers are required to provide clients who do not have insurance or who are not using insurance with an estimate of the expected charges for healthcare services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of your healthcare services, including psychotherapy services.
You may ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before scheduling a service.
The Good Faith Estimate outlines the costs of services that are reasonably expected for your healthcare needs. The estimate is based on information known at the time it is created.
The Good Faith Estimate does not include any unknown or unexpected costs that may arise during the course of treatment. If additional services become necessary, you will be provided with an updated Good Faith Estimate when appropriate.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill under federal law.
You may contact your healthcare provider to discuss the difference between the estimate and the bill, request an updated bill, inquire about financial assistance options, or seek additional clarification regarding charges.
You may also begin a dispute resolution process through the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must initiate it within 120 calendar days of the date on the original bill.
A fee may apply to participate in the dispute resolution process. Current fees and procedures are determined by HHS and may change over time.
For the most current information, to learn more about your rights, or to obtain forms related to the dispute process, please visit:
or call the U.S. Department of Health and Human Services at:
1-877-696-6775
We encourage you to keep a copy of your Good Faith Estimate for your records. You may need it if you are billed an amount that is significantly higher than the estimate provided.
If you have questions regarding your Good Faith Estimate, please contact Daniela Durazo Therapy & Coaching directly.