Patient Rights  ·  No Surprises Act

Good Faith Estimate

You have the right to know the expected cost of your care before your appointment. We are committed to transparency and will gladly provide a written estimate upon request.

Your Legal Right Written Estimate Provided Before Your Appointment Dispute Rights Included
Required by Federal Law
Uninsured & Self-Pay Patients
Written Estimate Available
Dispute Process Protected

What Is a Good Faith Estimate?

Under the No Surprises Act, health care providers are required by federal law to provide an estimate of expected costs to patients who do not have insurance or who choose not to use their insurance.

You Are Entitled to a Written Estimate

You have the right to receive a Good Faith Estimate in writing detailing the total anticipated cost of any non-emergency items or services — including fees for tests, prescription drugs, equipment, and hospital stays.

Receive It Before Your Appointment

You must receive your Good Faith Estimate in writing at least one business day before your medical treatment or service. You may also request an estimate before scheduling any item or service.

Right to Request From Any Provider

You can request a Good Faith Estimate from Carolina Blue Skies Counseling, as well as from any other provider you are considering, before scheduling a service — so you can make an informed decision.

Right to Dispute Unexpected Charges

You have the right to dispute a bill that is $400 or more above your Good Faith Estimate. Be sure to save a copy of your estimate for your records so you can reference it if needed.

Who This Applies To

The Good Faith Estimate requirement applies to patients who:

Do not have health insurance
Have insurance but choose not to use it for a particular service
Are receiving non-emergency scheduled services
Are self-pay patients or are paying out-of-pocket

If you are using insurance and Carolina Blue Skies Counseling is in-network with your plan, your cost estimate will come from your insurance provider rather than as a formal Good Faith Estimate.

What Is Covered in the Estimate

Your Good Faith Estimate will include the anticipated costs for all items and services reasonably expected as part of your care, which may include:

Individual, couples, or family therapy session fees
Initial intake/assessment session costs
Any telehealth or virtual session fees
Estimated total cost based on your planned course of care

The estimate is based on information known at the time of the request. Actual costs may differ if your care needs change.

Requesting Your Good Faith Estimate

Requesting a Good Faith Estimate is simple. Here's how:

1

Contact Our Office

Reach out to us by phone, email, or through our website. Let us know you would like a Good Faith Estimate before scheduling your appointment.

2

We Prepare Your Estimate

Our administrative team will prepare a detailed written Good Faith Estimate outlining your anticipated costs, which will be provided to you at least one business day before your scheduled service.

3

Save a Copy

Keep your written Good Faith Estimate in a safe place. You may need it to reference if there is a discrepancy between your estimate and your final bill of $400 or more.

Your Right to Dispute

If you receive a bill that is $400 or more above your Good Faith Estimate, you have the right to dispute the charges. Here's what to do:

1 Save a copy of your Good Faith Estimate and your final bill
2 Contact our office to discuss the discrepancy directly
3 If unresolved, contact CMS at 1-800-985-3059 or visit www.cms.gov/nosurprises
Visit cms.gov/nosurprises → Or call 1-800-985-3059 for more information

Ready to take the first step?

Reach out to request your Good Faith Estimate or to schedule your first appointment. We're here to make the process easy.