Your right to a Good Faith Estimate

Know the expected cost of care

Healthcare providers must give eligible uninsured or self-pay patients a written Good Faith Estimate of expected charges when services are scheduled at least three business days in advance, or when an estimate is requested. You can ask for one before deciding whether to schedule care.

The estimate should include expected charges for the healthcare items and services related to your care. It is an estimate, not a bill or a requirement to receive treatment.

When you should receive an estimate

• If you schedule care 3–9 business days in advance, the estimate must be provided within one business day after scheduling.
• If you schedule care at least 10 business days in advance, it must be provided within three business days after scheduling.
• If you request an estimate before scheduling, it must be provided within three business days of your request.

Save a copy of your estimate so you can compare it with any bills you receive.

If a bill is higher than your estimate

If a provider’s bill is at least $400 more than that provider’s Good Faith Estimate, you may be eligible to use the federal patient–provider dispute resolution process. A dispute must generally be started within 120 calendar days of the date on the initial bill.

Questions or an estimate request

Contact Bergen Psychology Services at (201) 366-2442 to discuss expected charges or request an estimate. Individual therapy is $250 per 50-minute session.

For details about these rights, visit CMS: medical bill rights when not using insurance and CMS: Good Faith Estimates.

This notice describes estimate rights. Your individualized estimate will reflect the services planned for your care.

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