OMB Control Number: 0938-1401

 

Right to Receive a Good Faith Estimate of Expected Charges

Under the law, health care providers must give patients who don’t have insurance, or who are not using insurance, an estimate of the expected charges 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 facility fees.

  • Your health care provider must give you a Good Faith Estimate in writing at least 1 business day before your scheduled medical service or item. You can also ask for a Good Faith Estimate before you schedule an item or service.

  • If you receive a bill that is at least $400 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 or call 1-800-985-3059.

 

Important Note About Forensic Services

Atlas Psychological Services, LLC provides both clinical and forensic services.

  • The Good Faith Estimate requirements apply to uninsured or self-pay individuals seeking clinical services (such as therapy or psychological testing for treatment purposes).

  • Forensic evaluations (e.g., court-ordered assessments, attorney- or employer-retained evaluations, independent medical exams, and related expert services) are generally outside the scope of these requirements, because they are most often arranged and paid for by third parties.

  • However, if an individual is personally responsible for payment, then the Good Faith Estimate protections do apply.