31201 Chicago Road, Suite A 201, Warren, Michigan 48093, United States
Good Faith Estimate
Disclaimer for Good Faith Estimate for Cash Pay and Out-of-Network ClientsAs of January 1, 2022, all healthcare providers must offer “Good Faith Estimates” of anticipated therapy costs to private-pay clients or clients utilizing out-of-network providers at in-network facilities at the start of treatment or upon request. We are committed to providing our clients with transparency and clarity regarding therapy costs.
During the intake session, you will receive an individualized Good Faith Estimate as part of the practice policy form, which will outline the anticipated costs of therapy for the year based on the mutually agreed-upon and predetermined rate. If you receive a bill that exceeds your Good Faith Estimate by $400 or more, you have the right to formally dispute that bill. We encourage you to retain a copy or a digital image of your Good Faith Estimate for your records.
For additional inquiries or further information concerning your rights pertaining to the Good Faith Estimate, please visit www.cms.gov/nosurprises or contact us at 1-877-696-6775.Please contact us for any additional questions you may have. We look forward to hearing from you! If you are a current patient and have a billing question please email themindfulselfcounseling@gmail.com