Good Faith Estimate Availability Notice

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.
  • Summit Emotional Health strives to provide Good Faith Estimates to all patients at the time of scheduling. These Good Faith Estimates are provided by the Intake, Psychiatric, Assessment Coordinator and/or the Front Desk Administrator. If a Good Faith Estimate cannot be provided at the time of scheduling for any reason, an administrative staff member will provide all self-pay patients with a Good Faith Estimate, in writing, prior to services being rendered.
  • Summit Emotional Health attempts to provide Good Faith Estimates in accordance with state and federal guidelines.
  • 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.

Self-pay patients seeking a Good Faith Estimate may contact the following administrative team members:

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises

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