Good Faith Estimate Notice
Your Right to a Good Faith Estimate
Under federal law, you have the right to receive a “Good Faith Estimate” explaining the expected cost of medical and mental health services.
What This Means
If you are:
Uninsured
Not using insurance (self-pay)
You are entitled to receive an estimate of expected charges before receiving services.
Estimate Details
Your Good Faith Estimate will include:
Expected cost of services
Number of sessions (if applicable)
Any additional fees
Dispute Process
If you receive a bill that is at least $400 more than your estimate, you have the right to dispute the charges.
You can initiate a dispute through the U.S. Department of Health and Human Services.
Important Note
This estimate does not include:
Unexpected or additional services
Emergency care
Questions
If you have questions or would like to receive a Good Faith Estimate:
Email: info@seloropsychiatriccare.com