Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who do not have insurance — or who choose not to use insurance for privacy reasons — an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services that I offer. This includes related costs like add-on services, collateral encounters, psychological testing, court appearances, copy/postage fees, etc.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. Effective January 1, 2022, — as a part of my routine intake process — all patients receive a Good Faith Estimate in writing at least 1 business day prior to their initial appointment. I may also provide additional or revised estimates as warranted at later times. You can also ask me, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Please, make sure to save a copy or picture of your Good Faith Estimates.

For general questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the U.S. Department of Health & Human Services at (800) 368-1019.