Good Faith Estimate

Collaborative Counseling Services, PLLC

Under the federal No Surprises Act, individuals who do not have health insurance or who choose not to use their insurance benefits have the right to receive a Good Faith Estimate explaining the expected cost of mental health services.

A Good Faith Estimate provides an estimate of anticipated charges before services are provided. For ongoing psychotherapy, the estimate may cover expected services for up to 12 months.

Your Rights Include:

• Receiving a Good Faith Estimate when required by federal law or upon request.
• Receiving an estimate in writing, including electronically.
• Disputing a bill if it is at least $400 more than the Good Faith Estimate from that provider.
• Requesting a copy of your estimate for your records.

A Good Faith Estimate is not a bill and does not obligate you to receive services.

Questions or Requests

For questions about Good Faith Estimates, contact Collaborative Counseling Services, PLLC at:

Phone: 727-428-8288
Email: info@thecollaborativecounseling.com

For additional information about your rights under the No Surprises Act, visit:

https://www.cms.gov/nosurprises