your rights
Good Faith Estimate
No Surprises Act Disclosure
Your Right to a Good Faith Estimate
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 don't have insurance or who are not using insurance an estimate of the bill for medical items and services.
What This Means for You
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- 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. You can also ask your health care provider, 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.
Our Standard Fees
Individual Therapy Session (53 minutes): $175
The total cost of therapy depends on the number of sessions needed, which varies by individual. We will discuss your treatment plan and provide a personalized estimate during your initial consultation.
Important Information
Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
Dispute Resolution
If you are billed for more than your Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
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.
Contact Us
If you have questions about Good Faith Estimates or our fees, please contact us:
Creative Hearts Counseling, LLC
Clinton, Connecticut
Phone: (475) 522-1149
Email: brittany@creativeheartscounseling.org