YOUR RIGHT TO A GOOD FAITH ESTIMATE

Shady Tree Psychology LLC

You have the right to receive a Good Faith Estimate explaining how much your health care will cost.

Under federal law, health care providers are required to provide patients who do not have insurance or who are not using insurance to pay for their care with an estimate of the expected charges for scheduled health care services when applicable.

If you schedule services at least 3 business days in advance, you are generally entitled to receive a Good Faith Estimate in writing before your scheduled service. You may also ask Shady Tree Psychology LLC for a Good Faith Estimate before scheduling a service.

A Good Faith Estimate shows the expected cost of services that are reasonably expected based on the information known at the time the estimate is prepared. Because the frequency and duration of psychotherapy can vary depending on individual needs, your actual course of treatment may differ from the initial estimate. You may discuss changes in anticipated treatment frequency or costs with Dr. Savage at any time.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill through the federal patient-provider dispute resolution process.

Please save a copy of any Good Faith Estimate you receive.

To request a Good Faith Estimate from Shady Tree Psychology LLC, contact:

Shady Tree Psychology LLC
Isabella Savage, PsyD
318-200-0533
dr.savage@shadytreepsychology.com

For additional information about your rights under the No Surprises Act and Good Faith Estimate requirements, visit the Centers for Medicare & Medicaid Services.