Good Faith Estimate
Your Right to a Cost Estimate Under the No Surprises Act
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
This requirement applies to uninsured and self-pay clients under the No Surprises Act.
What is the No Surprises Act?
The No Surprises Act, which went into effect on January 1, 2022, protects patients from unexpected medical bills. Under this law, healthcare providers must give patients who don't have insurance or who are not using insurance an estimate of the expected charges for medical services.
Your Rights Under the Law
Under the law, healthcare providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services. This is called a Good Faith Estimate.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
- The Good Faith Estimate must be provided in writing at least 1 business day before your service or item.
- You can also ask for a Good Faith Estimate before you schedule an item or service.
Who Does This Apply To?
You have the right to a Good Faith Estimate if you:
- Don't have health insurance
- Are not using your health insurance for the service
- Are paying out-of-pocket for services
If you have health insurance and plan to use it, this law does not apply to you, but you can still request cost information from your provider and insurance company.
What Will the Good Faith Estimate Include?
Your Good Faith Estimate will include:
- A list of expected items or services, including their costs
- Diagnosis codes (ICD-10) when applicable
- Service codes (CPT codes)
- The name and National Provider Identifier (NPI) of the provider
- The location where services will be provided
- Expected dates of service
Our Standard Fees
Below are our standard self-pay rates for speech-language pathology services. Your personalized Good Faith Estimate may differ based on your specific treatment plan.
| Service | Fee |
|---|---|
| Initial Evaluation (60 min) | $200 - $300 |
| Therapy Session (30 min) | $75 - $100 |
| Therapy Session (60 min) | $150 - $200 |
| Free Consultation (15 min) | No charge |
*Fees are subject to change. A personalized Good Faith Estimate will be provided based on your treatment plan.
What Happens If the Bill Is Higher?
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059.
How to Request a Good Faith Estimate
To request a Good Faith Estimate, please contact us before scheduling your appointment:
ConnectedMinds SLP
Email: hello@remindctc.com
Phone: (123) 456-7890
Please provide:
- Your name and date of birth
- The type of service you are requesting
- Whether you have insurance (and if you plan to use it)
We will provide your Good Faith Estimate within 1 business day of scheduling or upon your request.