GOOD FAITH ESTIMATE
Notice to Clients and Prospective Clients
Under the federal No Surprises Act, healthcare providers are generally required to provide clients who do not have health insurance or who choose not to use their health insurance with a Good Faith Estimate of the expected charges for scheduled healthcare services, including psychotherapy services.
Your Right to a Good Faith Estimate
You have the right to receive a Good Faith Estimate explaining how much your healthcare services are expected to cost.
If you are uninsured or do not intend to use your health insurance to pay for counseling services, Conexión Counseling PLLC will provide a Good Faith Estimate when required by federal law.
You may also request a Good Faith Estimate before scheduling a service or at any time during treatment.
When You Will Receive an Estimate
Generally:
If you schedule services 3–9 business days in advance, the Good Faith Estimate must be provided no later than 1 business day after scheduling.
If you schedule services 10 or more business days in advance, the Good Faith Estimate must be provided no later than 3 business days after scheduling.
If you request a Good Faith Estimate before scheduling services, it generally must be provided within 3 business days of your request.
A Good Faith Estimate is generally not required when a service is scheduled fewer than 3 business days in advance.
Your Estimate May Change
A Good Faith Estimate is an estimate of the reasonably expected cost of your services and is not a contract or guarantee of the exact number, frequency, or duration of counseling sessions you may need.
Your treatment needs may change over time. If there is an anticipated change in the services, frequency, duration, or expected charges included in your Good Faith Estimate, an updated estimate may be provided as required by law.
You are always welcome to discuss the expected cost of counseling with Conexión Counseling.
If Your Bill Is Higher Than Your Estimate
If you receive a bill from a provider that is at least $400 more than the amount listed on that provider's Good Faith Estimate, you may be eligible to use the federal patient-provider dispute-resolution process.
Keep a copy of your Good Faith Estimate and compare it with the bills you receive.
Questions About Your Good Faith Estimate
If you have questions about your Good Faith Estimate or the expected cost of counseling services, please contact:
Conexión Counseling PLLC
1414 North Meadow Avenue, Suite 1
Laredo, TX 78040
Telephone: (956) 439-8553
Email: info@conexioncounseling.com
For additional information about your federal rights under the No Surprises Act, Good Faith Estimates, or the patient-provider dispute-resolution process, visit the Centers for Medicare & Medicaid Services (CMS) No Surprises website.