Good Faith Estimate Notice

Your Right to Receive a Good Faith Estimate
Under the No Surprises Act

At Bright Star Consultation, LLC, transparency and trust are important to us. You have the right to receive a Good Faith Estimate explaining how much your mental health care will cost.

Under federal law (Section 2799B-6 of the Public Health Service Act), health care providers must give clients who don’t have insurance or aren’t using insurance an estimate of the expected charges for non-emergency services.

What You Can Expect

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including therapy sessions, assessments, and related charges.

  • Your estimate will be provided in writing before your scheduled service or upon request.

  • You can request a Good Faith Estimate from this practice or any other provider before scheduling a service.

  • If you receive a bill that is $400 or more than your Good Faith Estimate, you have the right to dispute the charge.

  • Keep a copy or photo of your Good Faith Estimate for your records.

How to Dispute a Bill

If you receive a bill that’s at least $400 more than your Good Faith Estimate, you can dispute it.

You may start a dispute resolution process with the U.S. Department of Health and Human Services (HHS).

You must start this process within 120 calendar days of receiving the bill.

For more information, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Questions?

If you have any questions or would like a Good Faith Estimate before starting services, please contact:
📞 (502) 260-7896
📧 justin@brightstarky.com