Good Faith Estimate "No Surprises Act"
Overview
As mandated by the No Surprises Act (effective January 1, 2022), healthcare providers must offer a Good Faith Estimate (GFE) of expected charges for services. This applies to individuals who are not using insurance or Federal health programs.
Purpose
The GFE provides an estimate of the expected costs for psychotherapy services at Alina P. Halonen, LPCC. It is based on current information and is not a binding contract. The estimate excludes unforeseen expenses or additional services that may be recommended and are not listed.
Limitations
The GFE does not account for unexpected costs that may arise during treatment. Additional services recommended as part of your care, but not included in the original estimate, will be billed separately.
Right to Dispute
If the actual charges exceed the GFE by $400 or more, you have the right to dispute the bill. You may contact the provider to adjust the bill, negotiate the charges, or inquire about financial assistance. Alternatively, you can initiate a dispute resolution process through the U.S. Department of Health and Human Services (HHS).
Dispute Resolution Process
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Time Frame: You must start the dispute process within 120 days of receiving the original bill.
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Fee: A $25 fee is applicable to initiate the dispute process.
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Outcome: Depending on the result of the dispute resolution, you will either pay the GFE amount or the higher billed amount.
Additional Information and Assistance
For more information about your GFE rights or the dispute resolution process:
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Call: 1-800-985-3059
The dispute process will not impact the quality of services provided.