Your Right to a Good Faith Estimate

Under the No Surprises Act, you have the right to receive a Good Faith Estimate explaining the expected cost of all health care services.

If you are uninsured or are not using insurance to pay for your care, you have the right to receive a written Good Faith Estimate of the expected charges for non-emergency health care services, including psychotherapy services.

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You may ask for a Good Faith Estimate before you schedule a service. You may also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before receiving services.

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A Good Faith Estimate is an estimate of the costs reasonably expected for the services discussed. It is not a contract and does not require you to receive services from this practice.

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If Your Bill Is Higher

If you receive a bill that is at least $400 more than your Good Faith Estimate from a provider or facility, you may have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process.

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To preserve this right, keep a copy or photo of your Good Faith Estimate and your bill. In general, you must begin the dispute process within 120 calendar days of the date listed on the original bill.

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Questions or Requests

You may request a Good Faith Estimate by contacting Self-Unlimited Counseling and Coaching, LLC before scheduling services or at any time during care.

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For more information about your right to a Good Faith Estimate or the federal dispute process, visit CMS No Surprises Act resources or call 1-800-985-3059.