Good Faith
Estimate.

Your Right to a Good Faith Estimate

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

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.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
• Make sure your healthcare 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 healthcare provider, 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.

Typical Session Charges at Poplar Belief Therapy

The actual total cost depends on the recommended frequency and length of treatment, which we'll discuss together during your intake. A personalized written Good Faith Estimate will be provided to you upon request or before scheduling.

Questions or to dispute a bill

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

To request a written Good Faith Estimate from us, email info@poplarbelieftherapy.com or call 832-334-7146.