Your Right to Receive a Good Faith Estimate

Under the federal No Surprises Act, individuals who do not have health insurance or who choose not to use health insurance to pay for services have the right to receive a Good Faith Estimate of the expected cost of their care.

You may request a Good Faith Estimate before scheduling services. You will also be provided an estimate when services are scheduled at least three business days in advance, as required by federal law. The estimate will explain the services reasonably expected to be provided and the anticipated charges associated with those services.

A Good Faith Estimate is not a bill. Actual costs may differ if your treatment needs, services, or frequency of appointments change.

If you receive a bill from a provider that is at least $400 more than the amount listed in that provider’s Good Faith Estimate, you may be eligible to use the federal patient-provider dispute resolution process.

Clients who are uninsured or paying for services without using insurance will receive additional written information about this right when establishing services.

To request a Good Faith Estimate, contact Jolly Counseling and Wellness LLC at ajolly@jollycounselingandwellness.com or 608-856-4424.

For more information about your rights, visit cms.gov/medical-bill-rights or call 1-800-985-3059.