Good Faith Estimate.

Purpose of the Good Faith Estimate

Under the law, healthcare providers are required to provide clients who don’t have insurance or who are not using insurance with an estimate of the expected charges for medical services, including mental health services. This is not a bill.

The client has the right to request a written explanation of any differences between the Good Faith Estimate and the actual charges.

If the actual billed charges are $400 or more than this estimate, you may be eligible to initiate a dispute resolution process.

This estimate is not a contract. You are not obligated to receive services from this provider.

You may request a new Good Faith Estimate at any time.