Good Faith Estimate

Your Right to Receive a Good Faith Estimate

Under the No Surprises Act, health care providers are required to give clients who are not using insurance, or who are not planning to use insurance, an estimate of the expected charges for medical and mental health services.

You have the right to receive a Good Faith Estimate explaining the anticipated cost of your care.

What a Good Faith Estimate Includes

A Good Faith Estimate includes reasonably expected costs for services provided by Inner Sanctum Therapy LLC. This may include the cost of psychotherapy sessions and other related fees discussed prior to the start of services.

Your Rights

You have the right to receive a Good Faith Estimate before your scheduled service or upon request. If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill.

Questions or Requests

To request a Good Faith Estimate or ask questions about fees and out-of-pocket costs, please contact:

Inner Sanctum Therapy LLC
info@innersanctumva.com
203-709-0446

For more information about your rights under the No Surprises Act, visit the Centers for Medicare & Medicaid Services website.