“NO SURPRISES ACT”
GOOD FAITH ESTIMATE (GFE)
Update Date: December 2023
​
Overview
​
As mandated by the No Surprises Act (effective January 1, 2022), healthcare providers must provide a Good Faith Estimate (GFE) of expected charges for services. This applies to individuals not using insurance or Federal health programs.
​
Purpose of the Good Faith Estimate
​
The GFE provides an estimated cost for health care services at Alina P. Halonen, LPCC’s psychotherapy practice. It's based on current information and is not a binding contract. It excludes unforeseen expenses and additional recommended services not listed.
​
Limitations of the Estimate
​
The GFE does not account for unexpected costs arising during treatment. Additional services recommended for your care, not included in this estimate, will be billed separately.
​
Right to Dispute
​
If your actual charges exceed the GFE by $400 or more, you have the right to dispute the bill. You can contact the provider to adjust the bill, negotiate, or inquire about financial assistance. Alternatively, you can initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS).
​
Dispute Resolution Process
​
-
Time Frame: Start within 120 days of receiving the original bill.
-
Fee: A $25 fee is applicable for initiating the dispute process.
-
Outcome: Depending on the dispute resolution, you'll pay either the GFE amount or the higher billed amount.
​
Additional Information and Assistance
​
For more details about GFE rights or dispute resolution:
​
-
Call: 1-800-985-3059
The dispute process will not impact the quality of services provided.