GOOD FAITH ESTIMATE NOTICE

(No Surprises Act Compliance)

You have the right to receive a Good Faith Estimate explaining how much your medical and mental health care will cost.

Under federal law, health care providers are required to give patients who do not have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services, before you schedule or receive those services.

You may request a Good Faith Estimate from Kayleigh Eden Therapy LLC at any time prior to scheduling services.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

Be sure to save a copy or picture of your Good Faith Estimate for your records.

For questions or more information about your right to a Good Faith Estimate, visit:
https://www.cms.gov/nosurprises
or call: (800) 985-3059

Important Notes

Good Faith Estimates are based on the information available at the time they are prepared and are subject to change if your treatment needs or frequency of sessions change.

Psychotherapy services are individualized, and total costs may vary depending on the number of sessions, session length, clinical needs, and whether additional services are requested.

Receiving a Good Faith Estimate does not obligate you to receive services.