Good Faith Estimate
The No Surprises Act requires me to provide a Good Faith Estimate of the cost of my services.
I, Carl E. Bradford PhD, will provide a Good Faith Estimate to you: (1). if I am not billing your health insurance or (2). if you ask me for an estimate. I will base the Good Faith Estimate on the best information that I have. Something unexpected might happen during your treatment that will change the cost of your treatment. If something unexpected happens and you are charged more than the Good Faith Estimate, then federal law says you may dispute (appeal) the bill.
So, if I bill you more than the Good Faith Estimate that I already gave you, then you may dispute the bill. If you choose to dispute the bill, here’s how to do it. First, let me know that you have noticed you are being charged more than the Good Faith Estimate. Then, ask me to update the bill so it matches the Good Faith Estimate. If I believe my charge is valid, then I might ask if we can talk about it and come to an agreement about what the charge will be.
If our talking does not resolve it, you also have the right to contact the U.S. Department of Health and Human Services (HHS) to resolve the difference between my charge and the Good Faith Estimate. However, you must contact the U.S. Department of Health and Human Services (HHS) within 120 calendar days of the date of the original bill. You also must pay $25 to HHS to get their help. If HHS agrees with you, then you are only responsible for the amount on the Good Faith Estimate. If HHS agrees with me, then you would be responsible to pay the higher amount. If you want to go this route or if you just want more information about the Good Faith Estimate dispute process,
go to this website: www.cms.gov/nosurprises/consumers
or call this number: 1-800-985-3059.
You can also get information from this other website: https://www.cms.gov/nosurprises/consumers/new-protections-for-you
Please feel free to ask me directly at any time if you have questions about a Good Faith Estimate.