Your Right to a "Good Faith Estimate"

You are entitled to receive a "Good Faith Estimate" detailing the expected costs of your medical care.

Under federal law, healthcare providers must provide an estimate of the total costs for medical items and services to patients who are uninsured or not using insurance.

What You Should Know:

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services. This includes related expenses, such as medical tests, prescription medications, equipment, and facility fees.

• Your healthcare provider must provide a written Good Faith Estimate at least 1 business day before your scheduled service or item.

• You can request a Good Faith Estimate from your healthcare provider or any other provider before scheduling a service.

• Our out-of-network fees for services can also be found on our website here.

What to Do If You’re Overcharged:

If you receive a bill that exceeds your Good Faith Estimate by $400 or more, you have the right to dispute the charges.

Keep a Copy:

Save a copy or take a picture of your Good Faith Estimate for your records.

Questions or More Information:

For more details about your right to a Good Faith Estimate, visit cms.gov/nosurprises.

For assistance, contact Haven Psychology Group:
Phone: (813) 438-4701
Email: admin@haven-psychology.com