No Surprises Act

Your Right to Receive a Good Faith Estimate

If you don't have health insurance, or you choose not to use your insurance to pay for therapy, you have the right to receive a Good Faith Estimate of expected charges. This is required under the federal No Surprises Act.

A Good Faith Estimate Isn't a Bill

The Good Faith Estimate lists the expected charges for services with Black Birch Counseling PLLC, based on what we know at the time we create it. For therapy, this usually includes the type of session, the fee per session, and the expected frequency and number of sessions over a period of up to 12 months. It won't include unexpected costs or services from other providers.

When You'll Receive It

• If you schedule at least 3 to 9 business days in advance, you'll receive your estimate within 1 business day of scheduling.

• If you schedule at least 10 business days in advance, you'll receive your estimate within 3 business days of scheduling.

• If you ask for an estimate before scheduling, you'll receive it within 3 business days of your request.

Your estimate will be provided in writing, on paper or electronically, based on your preference. We're also happy to walk you through it by phone or during a session, and it can be provided in an accessible format if needed.

If Your Bill Is Higher Than Your Estimate

Keep a copy of your Good Faith Estimate so you can compare it to any bills you receive. If you're billed $400 or more above your estimate, you may be eligible to dispute the bill.

Questions?

For more information about your right to a Good Faith Estimate, visit CMS: Good Faith Estimate or call the No Surprises Help Desk at 1-800-985-3059.

For questions about your estimate with Black Birch Counseling PLLC, contact us at steph@blackbirchcounseling.com.