Good Faith Estimate

Your Right to a Good Faith Estimate

You have the right to receive a "Good Faith Estimate" explaining how much your therapy services will cost.

Under the No Surprises Act, health care providers are required to give patients who don't have insurance or who are not using insurance an estimate of the expected charges for services.

As a private-pay practice, Coherent Mind Trauma Counseling provides a Good Faith Estimate to all clients.

What Is a Good Faith Estimate?

A Good Faith Estimate is a written document that shows the estimated cost of the therapy services you are expected to receive. This includes:

  • The services you are scheduled to receive

  • The expected charges for those services

  • Information about the provider delivering the services

The Good Faith Estimate is not a contract and does not require you to obtain services from this practice.

When You Will Receive a Good Faith Estimate

You will receive a Good Faith Estimate:

  • Before your first session, as part of your intake paperwork

  • Upon request at any time—just ask

  • When there are changes to your expected services or fees

  • Annually if you are an ongoing client, or sooner if your treatment plan changes

If you schedule services at least 3 business days in advance, you will receive your Good Faith Estimate within 1 business day of scheduling. If you schedule services within 3 business days, you will receive your Good Faith Estimate no later than the day of your scheduled service.

Important Information About Your Estimate

  • The Good Faith Estimate shows the costs of items and services that are reasonably expected for your therapy. The actual services you receive may differ based on your treatment needs.

  • The Good Faith Estimate is an estimate, not a final bill. Actual charges may vary if your treatment needs change during the course of care.

  • The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment.

  • You may be charged more if your therapy extends beyond what is estimated, or if additional services are recommended during your care.

Your Right to Dispute a Bill

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

You may contact the health care provider to negotiate the bill. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days of the date on the original bill.

There is a $25 fee to use the dispute resolution process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider, you will have to pay the higher amount.

To learn more and get a form to start the dispute process, go to: www.cms.gov/nosurprises

Questions?

For questions or to request a Good Faith Estimate, please call (757) 231-5308, email hello@thecoherentmind.com, or use the Contact Form on this website.

Coherent Mind Trauma Counseling
Cimo Psychotherapy Services, LLC
Dan Cimo, LCSW