Good Faith Estimate
Your Right to Receive a Good Faith Estimate
Under the No Surprises Act, you have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care may cost.
What is a Good Faith Estimate?
A Good Faith Estimate (GFE) is an estimate of the expected charges for services if you are not using insurance or are choosing to pay out-of-pocket.
This estimate helps you understand and plan for the cost of your care in advance.
Who can receive a Good Faith Estimate?
You have the right to receive a Good Faith Estimate if you:
Are not using insurance
Are choosing not to use your insurance
Are self-pay for services
What does the estimate include?
Your Good Faith Estimate will include:
The cost of individual therapy sessions
Any additional services that may be recommended
The frequency and duration of care (when known)
Because therapy is individualized, actual costs may vary depending on your needs and treatment progress.
When will I receive it?
You have the right to receive a Good Faith Estimate:
Before your first scheduled service
Upon request at any time
You can also ask for an updated estimate if your treatment needs change.
What if my bill is higher than my estimate?
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the charges.
Information about how to dispute a bill will be provided with your estimate.
Questions or Requests
If you would like to receive a Good Faith Estimate, or if you have any questions about your expected costs, please reach out:
Square One Counseling
jschopp@socounseling.com
www.socounseling.com