Right to Receive a Good Faith Estimate of Expected Charges

Under the No Surprises Act
(For use by health care providers no later than January 1, 2022)

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 a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is a significant amount more than your Good Faith Estimate, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate.

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

Expected Charges at Go Rogue Counseling and Wellness

Every person has a different experience with therapy and therefore may need more or less sessions. The session rate is $165 per 55-minute appointment. This means that if you attend 10 appointments, your expected charge would be $1650 ($165 × 10).

You will be informed in advance if fees are changing so that you can make an informed decision about your treatment.

If you have questions or concerns regarding session costs, you are welcome to ask at any time.