Your right to understand the cost of your care

Under the No Surprises Act, people who do not have health insurance or who choose not to use their insurance generally have the right to receive a written Good Faith Estimate of expected health care charges.

A Good Faith Estimate explains the charges reasonably expected for your scheduled services. You may also request an estimate before deciding whether to schedule care.

When you will receive your estimate

• If you schedule services 3–9 business days in advance, you will receive your estimate within 1 business day after scheduling.

• If you schedule services at least 10 business days in advance, you will receive your estimate within 3 business days after scheduling.

• If you request an estimate before scheduling, you will receive it within 3 business days of your request.

Services scheduled fewer than 3 business days in advance do not carry the same federal estimate requirement.

Your estimate is not a contract or a requirement to receive services. Actual charges may change if your treatment needs or the services you choose change. Any changes to the expected services and charges will be discussed with you.

If your bill is higher than your estimate

If a provider bills you at least $400 more than that provider’s Good Faith Estimate, you may qualify for the federal patient-provider dispute resolution process. You must begin that process within 120 calendar days of receiving the initial bill.

Keep a copy of your estimate and your bills.

Questions or requests

To request a Good Faith Estimate or ask about fees, contact:

Melanie Taylor, LPC-S
hello@melanietaylorlpc.com
479-370-4160

For more information about your rights, visit:
https://www.cms.gov/nosurprises