GOOD FAITH ESTIMATE AND NO SURPRISES ACT

Under the No Surprises Act, which became effective January 1, 2022, healthcare providers and facilities are required to provide patients who do not have insurance or who are not using insurance (self-pay patients) with a Good Faith Estimate of expected charges for scheduled services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

If you are uninsured or choose not to use your health insurance for services, you are entitled to receive a Good Faith Estimate of what your services will cost before your appointment. The Good Faith Estimate will include an itemized list of expected charges for the scheduled services and will be provided upon request or when you schedule an appointment. This estimate is based on information known at the time of scheduling and is subject to change based on services actually rendered, changes in your treatment needs, or other unforeseen circumstances that may arise during the course of treatment.

You have the right to initiate a patient-provider dispute resolution process if the actual billed charges substantially exceed the Good Faith Estimate provided (by $400 or more). To initiate the dispute resolution process, you must contact the U.S. Department of Health and Human Services at 1-800-985-3059 or visit www.cms.gov/nosurprises for more information. The dispute must be initiated within 120 calendar days of receiving the final bill that exceeds the Good Faith Estimate by the threshold amount.

For more information about your rights under the No Surprises Act, visit www.cms.gov/nosurprises or call 1-800-985-3059. You may also contact your health insurance company or the Pennsylvania Insurance Department if you have questions about your coverage or rights under this law.

If you are using insurance benefits for services, the Good Faith Estimate requirements do not apply. Instead, your insurance company will provide you with an Explanation of Benefits (EOB) that details your financial responsibility based on your specific insurance plan, including deductibles, copayments, and coinsurance amounts.

For any additional information or questions, please contact us at info@behindthemaskcounseling.com

Yearly estimated cost for weekly 1 hour individual therapy for 52 weeks at the standard fee of $200 is $10,400

Yearly estimated cost for weekly 1 hour couples therapy for 52 weeks at the standard fee of $225 is $11,700

If length or frequency of sessions change or the fee changes, this estimate will change.