Your Right to a Good Faith Estimate

No Surprises Act

Under federal law, health care providers are required to provide patients who do not have health insurance, or who are not using health insurance to pay for their care, with an estimate of the expected charges for scheduled health care services.

This is called a Good Faith Estimate.

You have the right to receive a Good Faith Estimate

If you are uninsured or plan to pay for services yourself without submitting claims to your health plan, you have the right to receive a Good Faith Estimate explaining the expected cost of your care.

You may request a Good Faith Estimate before scheduling a service.

When services are scheduled at least three business days in advance, a Good Faith Estimate will be provided within the timeframes required by federal law.

Your Good Faith Estimate will include the expected charges for the services reasonably anticipated as part of your care.

If your bill is substantially higher than your estimate

If you receive a bill from a provider that is $400 or more above the amount listed on that provider's Good Faith Estimate, you may have the right to dispute the bill through the federal patient-provider dispute resolution process.

Please keep a copy of your Good Faith Estimate so that you can compare it with future bills.

Questions or requests for an estimate

If you would like to request a Good Faith Estimate for services provided by Kennedy-Arenivar Mental Health Counseling PLLC, please contact the practice directly.

For additional information about your rights under the No Surprises Act, visit the Centers for Medicare & Medicaid Services website at CMS.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.

This notice is provided for informational purposes regarding rights established under the federal No Surprises Act.