Good Faith Estimate

Under a new law, health care providers are required to give patients who don’t have insurance or are not using insurance for their care a “Good Faith Estimate” of the anticipated costs of care for medical items and services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services provided by your provider.

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care treatment. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. The Good Faith Estimate only includes costs associated with anticipated treatment items and services, and does not include ancillary services, late or no show fees, or costs incurred from other medical providers (e.g., outside labs, pharmacies).

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill by contacting Baltimore Pediatric Psychology. You can also initiate a dispute resolution process with the US Department of Health and Human Services. For questions or more information about the dispute process, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059.