Good Faith Estimate

Fees will be provided to clients prior to starting therapy as part of their Good Faith Estimate. Please note that Dr. Berness is an out of network provider. Clients are highly encouraged to contact their insurance company prior to starting therapy in order to better understand their reimbursement for out of network psychological services.

Under the law, health care 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 and inform them of the following:

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.  You can also ask your health care providers, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• 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 or picture of your Good Faith Estimate.

• The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or the services from the provider identified in the Good Faith Estimate.

The U.S. Department of Health and Human Services (HHS) handles disputes initiated by patients.If you choose to use the dispute resolution system, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

There is a $25 fee to use the dispute process.If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate.If the agency disagrees with you and agrees with your health care provider, you will have to pay the higher amount.

To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 1-800-985-3059.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059.