Good Faith Estimate Notice

Good Faith Estimate Notice (No Surprises Act)

Under the No Surprises Act, health care providers must give clients who don’t have insurance or who are not using insurance an estimate of expected charges for medical services.

You have the right to receive a Good Faith Estimate for the total expected cost of therapy services. This includes any related fees for psychotherapy, diagnostic assessments, and other professional services.

• You have the right to request a Good Faith Estimate before scheduling a service or at any time during your care.
  
  
• If you receive a bill that is at least $400 more than your estimate, you may dispute the bill.
  
  
• Keep a copy of your estimate for reference.
  
  

If you’d like to request a Good Faith Estimate or have questions about your billing, please contact:
📧 admin@beyondthecouchcounseling.com
📞 616-209-9277

For more information about your rights, visit www.cms.gov/nosurprises.