Your Right to a Good Faith Estimate
Under the No Surprises Act, healthcare providers must inform individuals who don’t have insurance or who are not planning to use insurance about their right to receive a Good Faith Estimate of expected charges.
A Good Faith Estimate is required if you are:
- Uninsured
- Not planning to use insurance
- Using insurance but paying directly for some services
- Receiving services funded by a grant or third-party payer
- Using a Health Savings Account (HSA) or Flexible Spending Account (FSA)
When scheduling services at Mosaic Bloom Counseling LLC, you will receive a Good Faith Estimate which outlines:
- Expected charges for the initial therapy session
- Typical costs for ongoing therapy sessions
- Estimated frequency and duration of services
- Any known third-party payment arrangements or grant funding that may affect your costs
Even if another entity is paying for your care, you have the right to receive this estimate before your scheduled services. If you receive a bill that exceeds your Good Faith Estimate by $400 or more, you have the right to initiate a dispute resolution process.
For more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Contact us for any questions about fees, billing, or third-party payment arrangements:
Mosaic Bloom Counseling LLC Phone: 267-227-0122
