PATIENT PROTECTION & TRANSPARENCY

Good Faith Estimate Notice

Your rights and protections against surprise medical bills under the federal No Surprises Act.

Right to Receive a Good Faith Estimate of Expected Charges

Under Section 2799B-6 of the Public Health Service Act and the federal “No Surprises Act,” health care providers are required to provide patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.

Your Rights Under the No Surprises Act:

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy sessions.
You can request a Good Faith Estimate from your provider in writing at least one business day before your medical service or therapy session is scheduled.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through the federal dispute resolution process.
Make sure to save a copy or picture of your Good Faith Estimate for your records.

Questions and Dispute Information

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

Michael Rosner Therapy | Michael Rosner Marriage and Family Therapy, Professional Corporation
21241 Ventura Blvd, Suite 290, Woodland Hills, CA 91364 | (818) 457-9750

You don't have to navigate it alone.

Let's take the first step together.