In addition to providing transparent pricing on our website and in our practice paperwork, Market Street Psychotherapy provides Good Faith Estimates to eligible uninsured or self-pay patients when required by federal law and upon request.

Under the No Surprises Act, you have the right to receive a “Good Faith Estimate” explaining the expected cost of your care if you do not have health insurance or do not intend to use your health insurance to pay for your care.

• You have the right to receive a Good Faith Estimate of the expected charges for healthcare items or services provided by Market Street Psychotherapy when you request one or when eligible services are scheduled sufficiently in advance. Charges from other providers or facilities may be covered by separate estimates.

• If you schedule a healthcare item or service 3–9 business days in advance, your Good Faith Estimate generally must be provided in writing within 1 business day after scheduling.

• If you schedule a healthcare item or service at least 10 business days in advance, your Good Faith Estimate generally must be provided in writing within 3 business days after scheduling.

• You may also request a Good Faith Estimate before scheduling care. When you do, it generally must be provided within 3 business days after your request.

• If you receive a bill from a provider or facility that is at least $400 more than the Good Faith Estimate you received from that provider or facility, you may be eligible to dispute the bill through the federal patient-provider dispute resolution process.

• Keep a copy or picture of your Good Faith Estimate and any bills you receive.

  For questions or more information about your right to a Good Faith Estimate:

  Website: www.cms.gov/nosurprises/consumers
  Email: FederalPPDRQuestions@cms.hhs.gov
  Phone: 1-800-985-3059