Good Faith Estimate Notice

Under the law, health care providers must give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including counseling.

At Shoreline Counseling:

• You will be provided a written Good Faith Estimate during your first session.

• This estimate will include the expected cost of services, frequency of sessions (as discussed), and any other anticipated charges.

• The estimate is not a contract and does not obligate you to receive services.

• You may request a Good Faith Estimate at any time.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit:
www.cms.gov/nosurprises