Good Faith Estimate

Disclaimer

This Good Faith Estimate shows the costs of services that are reasonably expected for your mental health care needs. The actual items, services, or frequency may vary depending on your unique circumstances and needs.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.

If you are billed more than $400 above this estimate, you have the right to dispute the bill. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.