“NO SURPRISES ACT”
GOOD FAITH ESTIMATE (GFE)
Update Date: December 2023
Overview
As mandated by the No Surprises Act (effective January 1, 2022), healthcare providers must provide a Good Faith Estimate (GFE) of expected charges for services. This applies to individuals not using insurance or Federal health programs.
Purpose of the Good Faith Estimate
The GFE provides an estimated cost for health care services at Alina P. Halonen, LPCC’s psychotherapy practice. It's based on current information and is not a binding contract. It excludes unforeseen expenses and additional recommended services not listed.
Limitations of the Estimate
The GFE does not account for unexpected costs arising during treatment. Additional services recommended for your care, not included in this estimate, will be billed separately.
Right to Dispute
If your actual charges exceed the GFE by $400 or more, you have the right to dispute the bill. You can contact the provider to adjust the bill, negotiate, or inquire about financial assistance. Alternatively, you can initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS).
Dispute Resolution Process
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Time Frame: Start within 120 days of receiving the original bill.
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Fee: A $25 fee is applicable for initiating the dispute process.
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Outcome: Depending on the dispute resolution, you'll pay either the GFE amount or the higher billed amount.
Additional Information and Assistance
For more details about GFE rights or dispute resolution:
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Call: 1-800-985-3059
The dispute process will not impact the quality of services provided.