Good Faith (Surprise Billing) Statement

The No Surprises Act is part of a federal Public Health Service Act which was enacted in December 2020.  Based on our assessment of the law at that time, the law and subsequent requirements did not apply to the majority of our clients, predominantly in private practice settings.  This law is intended to protect consumers from receiving a “surprise bill” for an out of network medical or mental health services when they sought services from an in-network treatment facility.

  1. This Good Faith Estimate is required of all providers, which means any health care provider providing services under their license or certification.  This means all mental health providers in Colorado. 
  2. This estimate is to be provided to self-pay or uninsured clients.
  3. This estimate is to be provided when scheduling or upon client request, which means they need to know that they have the right to request this information.
  4. This is a non-binding estimate, provided, as the name implies, in good faith. 
  5. This estimate should include client name and date of birth; description of primary services; list of reasonably expected services; diagnostic codes and service codes and all associated fees with those codes; your NPI or Tax id, a disclaimer outlining that there may be additional services rendered; a disclaimer that this is a good faith estimate; and a disclaimer outlining how to dispute charges if warranted.
  6. Clients have the right to dispute any charges that are $400.00 or more over the charges outlined in the good faith estimate. 
  7. Our estimates are our best advised estimate, but of course estimates may change depending upon the course of therapy and the changing needs for treatment.
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