The Olive Counseling Center: Your Partner in Mental Health

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 bill for medical items and services.

● You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

● Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or 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 800-985-3059.

January 24, 2024

Dear Client,

In compliance with the No Surprises Act that went into effect January 1, 2022, all healthcare providers are required to notify clients of their Federal rights and protections against potential “surprise billing.” This Act requires that we notify you of your federally protected rights to receive a notification when services are rendered by an out-of-network provider, if a client is uninsured, or if a client elects not to use their insurance.

Additionally, we are required to provide you with a Good Faith Estimate of the cost of services (this will be emailed to you). It is difficult to determine the true length of treatment for mental health care and each client has a right to decide how long they would like to participate in psychotherapy services. Therefore, attached you will find a fee schedule for the services offered by your therapist. Your therapist will collaborate with you to determine how many sessions you may need.

Please review the Good Faith Estimate and let your therapist know if you have any questions.

Sincerely,

Carolyn Washington, LPC

The Olive Counseling Center