Good Faith Estimate (GFE) Notice for Self-Pay Clients

 

As required by the No Surprises Act (Effective January 1, 2022)

At Balanced Mind Wellness Center, we believe in transparency and clarity regarding the cost of your mental health care. If you are uninsured or choose not to use your insurance benefits, you are entitled to receive a Good Faith Estimate (GFE) of the expected cost of services.

What is a Good Faith Estimate?

Under the No Surprises Act, health care providers must give clients who are not using insurance an estimate of the total expected costs of non-emergency medical services, including therapy.

You have the right to receive a GFE in writing at least one business day before your scheduled appointment. This estimate will include the expected cost of sessions, the frequency of services (if known), and any additional fees related to your care.

Your Rights:

• You have the right to receive a written GFE explaining how much your care will cost.

• You can request a GFE before scheduling any service.

• If you receive a bill that is at least $400 more than your GFE, you can dispute the bill through the Patient-Provider Dispute Resolution process with the U.S. Department of Health and Human Services (HHS).

Services at Balanced Mind Wellness Center that Qualify for a GFE:

• Individual psychotherapy sessions (self-pay)

• EMDR Intensive services

• Any other service where you are not using insurance for payment

You can learn more about your rights under the No Surprises Act at https://www.cms.gov/nosurprises