No Surprise Act
No Surprises Act & Good Faith Estimates
RIGHT TO RECEIVE A GOOD FAITH ESTIMATE OF EXPECTED CHARGES
Under the No Surprises Act
You have the right to receive a Good Faith Estimate explaining how much your mental health care services are expected to cost.
Under federal law, health care providers are required to provide patients who do not have insurance or who are not using insurance (self-pay/private pay) with an estimate of expected charges for non-emergency health care services.
Your Rights Under the No Surprises Act
You have the right to:
Receive a Good Faith Estimate for the total expected cost of any non-emergency mental health services. This includes anticipated charges for psychotherapy sessions and any related services that are reasonably expected to be provided.
Receive your Good Faith Estimate in writing at least one business day before your scheduled service. You may also request a Good Faith Estimate at any time before scheduling services.
Request a Good Faith Estimate from this provider or from any other provider of your choosing.
Receive a copy of your Good Faith Estimate for your records.
Billing Disputes
If you receive a bill that is $400 or more above the amount listed in your Good Faith Estimate, you have the right to dispute the bill.
Dispute resolution instructions and timelines are established by the U.S. Department of Health and Human Services (HHS).
Important Notes
Good Faith Estimates are based on information known at the time the estimate is provided. Actual services provided may differ due to clinical needs, scheduling changes, or treatment decisions made collaboratively during care.
The Good Faith Estimate does not guarantee services or establish a therapist–client relationship.
More Information
For questions or more information about your right to receive a Good Faith Estimate:
Visit: https://www.cms.gov/nosurprises
Call: 1-800-985-3059
You may also contact:
Kalyn Mattis
The Healing Space
Provisionally Licensed – Georgia
📧 Email: contact@kalynlmattis.com