Good Faith Estimate Law Information
Notice About the No Surprises Act
L. Rebecca Connell, LCSW
LCS19814
(510) 594-8224
I will collaborate with you throughout your treatment to determine how many sessions you may need to receive the greatest benefit based on your concerns.
When you make an appointment, I will provide you with a written Good Faith Estimate.
You have the right to receive a “Good Faith Estimate” explaining how much your mental health care will cost. Under the federal No Surprises Act, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy. You can ask your health care provider for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
You may contact me to let me know the billed charges are higher than the Good Faith Estimate. You can ask me to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. Please contact me at (510) 594-8224 or leave me an encrypted email.
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 (about 4 months) of the date on the original bill.
There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 985-3059.
L. Rebecca Connell, LCSW
LCS19814
(510) 594-8224
I will collaborate with you throughout your treatment to determine how many sessions you may need to receive the greatest benefit based on your concerns.
When you make an appointment, I will provide you with a written Good Faith Estimate.
You have the right to receive a “Good Faith Estimate” explaining how much your mental health care will cost. Under the federal No Surprises Act, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy. You can ask your health care provider for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
You may contact me to let me know the billed charges are higher than the Good Faith Estimate. You can ask me to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. Please contact me at (510) 594-8224 or leave me an encrypted email.
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 (about 4 months) of the date on the original bill.
There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 985-3059.
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Want to talk more about how I could help you? Call 510-594-8224. You can leave a message at any time. You can also leave me an encrypted email here. Integrative Health Education for Anxiety and Depression, Couples Counseling, Mental Health Nutrition, Eating Meditation, Body Liberation, LGBTQIA+ Trauma, Emotional Freedom Techniques and Energy Psychology Continuing Education for Psychologists, Therapists, Nurses, and Health Coaches Oakland, Berkeley, San Francisco Bay Area, live online in California Boulder, Denver, live online in Colorado Spanish-speaking therapist • psicoterapia y consejería en español Privacy Policy |