You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under Section 2799B-6 of the Public Health Service Act (“No Surprises Act”) health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.
You will receive a personalized Good Faith Estimate, available in the patient portal, based on the fee that we discussed before initiating treatment. You do not need to sign this document and it does not constitute a contract between us. Before we can initiate treatment you do need to sign the Client-Psychotherapist Agreement consenting to treatment with me, which also details the cost per session and informs you that I may raise my session fee at the start of each calendar year and will provide 2 months notice prior to any fee increase.
You are free to terminate services with me at any time and payment is only collected per service provided, or per service scheduled and not cancelled within 24 hours, as per our Client-Psychotherapist Agreement. Therefore you should never receive a surprise medical bill or have any unforeseen expenses as part of your treatment with me.
For questions or more information about your right to a Good Faith Estimate, or other protections under the No Surprises Act, visit www.cms.gov/nosurprises