GOOD FAITH ESTIMATE

At Healing Words Therapy, we believe in transparent pricing and ensuring you understand the cost of your care upfront. You have the right to receive a clear estimate of your medical bill.

Under federal law, specifically Section 2799B-6 of the Public Health Service Act, healthcare providers like Healing Words Therapy are required to inform you of your right to a "Good Faith Estimate" for your expected medical care costs. This means that if you're uninsured, or if you choose not to use your health insurance for our services, we'll provide you with an estimate of your bill for mental health items and services. You have the right to receive a Good Faith Estimate that explains the total expected cost of any non-emergency items or services, which can include your therapy sessions, initial assessments, and any other directly related services.

A Good Faith Estimate (GFE) is a document that provides an estimate of the expected charges for your mental health services, including psychotherapy. It's designed to protect you from unexpected "surprise" bills by giving you a clear understanding of potential costs before you begin treatment.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.

• Upon Request: You can ask your therapist or our administrative team for a Good Faith Estimate at any time, even before you schedule a service.
• Automatically Provided: If you're uninsured or choose not to use your insurance, we'll automatically provide you with a Good Faith Estimate in writing at least  [1] business day before your first scheduled service. We'll also provide one upon your request for any future services. The Good Faith Estimate will list the estimated costs for items and services that are reasonably expected for your mental health care at Healing Words Therapy.

The Good Faith Estimate shows the costs of items and services that are reasonably expected for your healthcare needs. It's an estimate based on what's known at the time and doesn't include any unexpected costs that might arise during treatment.

If you receive a bill that's at least $400 more than your Good Faith Estimate, you can dispute the bill. You can contact us to let us know the billed charges are higher than the Good Faith Estimate. You can ask us to update the bill to match the Good Faith Estimate, negotiate the bill, or ask to dispute the bill with the U.S. Department of Health and Human Services (HHS).

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

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

• A Good Faith Estimate is not a contract and doesn't require you to obtain the services listed.
• The estimate doesn't include services that might be recommended by other healthcare providers or any unforeseen services that might arise during your course of treatment.
• The actual charges may vary depending on the services rendered.

We're committed to providing you with clear and understandable information regarding your therapy costs at Healing Words Therapy. Please don't hesitate to contact us if you have any questions.