Good Faith Estimate Notice

Under the No Surprises Act, individuals who are uninsured or choose not to use their health insurance have the right to receive a Good Faith Estimate of the expected costs of healthcare services.

A Good Faith Estimate outlines the anticipated costs of services before you receive care.

You have the right to:

• Receive a Good Faith Estimate before your scheduled services.

• Ask questions about your estimate.

• Keep a copy of your estimate for your records.

If you receive a bill that is substantially higher than your Good Faith Estimate, you may have the right to dispute the charges.

Additional information about your rights under the No Surprises Act is available from the Centers for Medicare & Medicaid Services (CMS).

If you have questions about fees or would like to request a Good Faith Estimate, please contact:

Maraina Mantie, MA, LPCA

Email: maraina@healthrutherapy.org

Phone: (860) 264-5578