Good Faith Estimate

• You have the right to receive a Good Faith Estimate of the total expected cost of non-emergency services, including therapy sessions.
• The estimate comes in writing. If you schedule at least three business days ahead, you receive it within one business day of scheduling. If you schedule at least ten business days ahead, you receive it within three business days of scheduling.
• You can also ask for a Good Faith Estimate before you schedule. We provide it within three business days of your request.
• The estimate is not a contract, and it does not require you to receive any service from us.
• Keep a copy or a photo of your Good Faith Estimate so you can compare it with your bills.

If you are paying for therapy yourself, our office gives you a Good Faith Estimate when you schedule. Because therapy usually involves a series of sessions, the estimate is based on the expected number of sessions over a period of up to 12 months, and we give you an updated estimate if your plan of care changes.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through the federal patient-provider dispute resolution process. You must start the dispute within 120 calendar days of the date on the original bill. There is a $25 fee to use the process. We will not take any action against you for starting a dispute.

For questions about your estimate, call our office at (385) 224-5128. For more information about your rights, or to start a dispute, visit www.cms.gov/nosurprises (opens in a new tab) or call 1-800-985-3059.