Good Faith Estimate
No Surprises Act

Right to Receive a Good Faith Estimate
Notice Required Under the No Surprises Act

Under Section 2799B-6 of the Public Health Service Act, health care providers are required to give patients who are not using insurance, or who are not enrolled in a health plan, an estimate of expected charges for services.

You have the right to receive a Good Faith Estimate of the cost of services if you are not using insurance to pay for care, including psychotherapy and evaluation services offered by Intuitive Healing Therapy, PLLC.

• You will receive a Good Faith Estimate in writing at least 1 business day before your first scheduled appointment, or sooner upon request.

• The estimate will show the expected cost of services based on the information available at the time.

• This is only an estimate. Actual charges may differ, particularly if the number or type of sessions needed changes based on your treatment plan.

• If you are billed for an amount that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

For questions or to request a Good Faith Estimate, contact:

Intuitive Healing Therapy, PLLC
Phone: (989) 439-0804
Email: whitneyw@intuitivehealingtherapypllc.com

For more information about your rights under the No Surprises Act, visit www.cms.gov/nosurprises or
call 1-800-985-3059.