Under Section 2799B-6 of the Public Health Service Act, known as the “No Surprise Act”, health care providers and health care facilities are required to provide a Good Faith Estimate of expected charges for items and services to individuals who are not enrolled in a health care plan, coverage, a Federal health care program, or not seeking to file a claim with their plan or coverage either orally or in writing, upon request or at the time of scheduling health care items and services.

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The information provided in the Good Faith Estimate is only an estimate, and the actual items, services, or charges may differ from what is included in the Good Faith Estimate. However, uninsured or self-pay individuals may challenge their bill if the billed charges substantially exceed the expected charges in the Good Faith Estimate. Fair resolution options will be provided to ensure clients pay only the agreed upon rates given via writing in the fee schedule listed.

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At any time, you may request additional written or verbal confirmations of said services and fees before agreeing to further services. In the event any information provided in the estimate changes a new Good Faith Estimate included in an updated Consent to Services Contract would be provided no later than one (1) business day before the next scheduled session. If the updated estimate is not provided as required, the original Good Faith Estimate will be honored until an updated Consent is provided. You may contact Lockesmith Psychotherapy via phone or email if additional questions about clinical services or billed fees arise.