Good Faith Estimate

Notice under the federal No Surprises Act

This document is a starting template for McMahon Mental Health. Erin should review and adapt it with her own professional and legal judgment before relying on it.

Your right to a Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychiatric and mental health care.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including related costs like exams and follow-up care.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Requesting an estimate

To request a Good Faith Estimate before scheduling, contact us at erin@mcmahonmentalhealth.com.