Notice of Good Faith Estimate
Last Updated: November 1, 2024
Transparency in Your Care Costs
Dr. Jenny Shields is committed to providing clear and transparent information about your treatment costs. Under the No Surprises Act (NSA), all healthcare providers, including our practice, are required to offer a Good Faith Estimate (GFE) of expected service costs to individuals who are uninsured or self-pay. We believe in going above and beyond by providing this information upfront to foster transparency and peace of mind for all clients, whether at the start of a service request or throughout our treatment relationship.
What is a Good Faith Estimate?
A Good Faith Estimate is a written statement of expected charges for your mental health services. This estimate outlines the anticipated costs of services, based on the information available at the time you request an appointment or initiate care. Please note that while a Good Faith Estimate reflects our best approximation, it may not cover every potential charge, especially if the scope or duration of your treatment changes.
Your Right to a Good Faith Estimate
Under the No Surprises Act, individuals without insurance or choosing self-pay are entitled to receive a Good Faith Estimate:
At the Start: Typically provided when scheduling a new service or upon request before committing to care.
Upon Request: You may request a Good Faith Estimate at any time by contacting our office.
How We Provide Your Estimate
To ensure transparency, you will receive your Good Faith Estimate in writing within three business days from the date of your request or when scheduling an appointment. This estimate will cover the anticipated services, including session frequency and related costs for any treatments discussed.
If Actual Charges Exceed Your Estimate
If the final bill for your treatment exceeds the Good Faith Estimate by $400 or more, you have the right to dispute the charges:
Contact Us: Begin by reaching out to our office to discuss the charges. We are here to address any concerns.
File a Dispute: You may file a dispute directly with the U.S. Department of Health and Human Services (HHS) within 120 days of receiving your bill.
To file a dispute, please visit HHS’s Dispute Resolution Process or call HHS at 1-800-985-3059.
What the Good Faith Estimate Includes
Your Good Faith Estimate will provide:
Detailed Service Descriptions: Types of services you may receive (e.g., individual therapy sessions, assessments, group therapy, etc.)
Estimated Costs: Expected fees based on the treatment plan discussed with you.
Frequency of Services: How often we anticipate you may need to attend sessions to meet your treatment goals.
Additional Information
Estimate Adjustments: Changes to your treatment may impact the estimated costs. If adjustments occur, we will provide an updated estimate.
Exceptions: Emergency services or other unplanned treatments may not be covered by the initial estimate but will be discussed in real time when possible.
Contact Us
We’re committed to transparency and to ensuring that you feel informed and confident about your care.
If you have questions about your Good Faith Estimate or would like to request an estimate, please contact us directly by email at support@drjennyshields.com