Good Faith Estimate

Your right to know the cost of your care before treatment begins.

The No Surprises Act

Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or who are not seeking to file a claim with their plan or coverage — both orally and in writing — of their ability to receive a Good Faith Estimate of expected charges.

This federal law, effective January 1, 2022, protects you from unexpected medical bills and ensures you understand the cost of your care before you receive services.

Your rights

You have the right to receive a Good Faith Estimate explaining how much your mental health care will cost.

  • You can ask your health care provider for a Good Faith Estimate before you schedule a service, or at any time during treatment
  • If you schedule a service at least 3 business days in advance, the provider must provide the Good Faith Estimate within 1 business day after scheduling. If you schedule a service at least 10 business days in advance, the estimate must be provided within 3 business days after scheduling
  • You can also ask any provider for a Good Faith Estimate before you schedule an item or service. If you do, the provider must give you an estimate within 3 business days

What a Good Faith Estimate includes

A Good Faith Estimate will include the expected charges for the primary service and any other items or services that are reasonably expected to be provided together with the primary service. This includes:

  • The service to be provided (e.g., individual therapy session)
  • The expected fee per session
  • An estimate of the number and frequency of sessions recommended, based on your treatment plan
  • The expected total cost over a defined period
  • The diagnosis code(s), if applicable
  • The National Provider Identifier (NPI) and Tax Identification Number (TIN) for the provider

The estimate is based on information known at the time it is provided. Actual charges may differ if your treatment needs change, and you will be informed of any changes to the cost of your care.

How we provide your estimate

At Felicia Caulk, Behavioral Health LLC:

  • We will provide you with a written Good Faith Estimate before your first session as part of the intake and scheduling process
  • We will discuss fees openly and clearly so you understand the cost of your care before treatment begins
  • If your treatment plan changes in a way that affects cost, we will provide an updated estimate and discuss the changes with you
  • We will never provide a service and then surprise you with the cost afterward

If your bill is substantially different

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may contact the health care provider 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 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 the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider, you will have to pay the higher amount.

To learn more and get a form to start the process, go to cms.gov/nosurprises or call 1-800-985-3059.

Keep your estimate

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises.

We encourage you to save a copy of your Good Faith Estimate for your records. If you have questions about your estimate or your bill at any time, please contact us.

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