NO SURPRISES ACT

Good Faith Estimate

You have the entitlement to receive a "Good Faith Estimate" which will provide a breakdown of the anticipated expenses for your medical and mental health care. This legal requirement mandates healthcare providers to furnish uninsured patients or those not utilizing insurance with an estimate of the expected charges for medical services, including psychotherapy services.

You are eligible to request a Good Faith Estimate disclosing the total projected cost of any non-emergency healthcare services, including psychotherapy services, from your healthcare provider or any other chosen provider, before scheduling a service.

Existing clients (without insurance or not using insurance benefits) have the right to receive a "Good Faith Estimate" that outlines the estimated charges for psychotherapy services.

New clients (without insurance or not using insurance benefits) have the right to inquire about a Good Faith Estimate before their first scheduled session.

Please be aware that the Good Faith Estimate only provides an approximation based on reasonably expected costs for services rendered by Full Vida Therapy. The estimate is established using information available at the time of its creation and does not consider any reimbursement you might receive from out-of-network benefits. Moreover, the Good Faith Estimate does not include unforeseen or unknown costs that may arise during treatment. Additional services required during special circumstances may result in extra charges.

In the event that you receive a bill that exceeds your Good Faith Estimate by at least $400, you have the right to dispute the bill. It is advised to retain a copy or take a picture of your Good Faith Estimate for reference.

For any inquiries or further information regarding your right to a Good Faith Estimate, please visit www.cms.gov/nosurprises.