DISCLAIMER FOR GOOD FAITH ESTIMATE FOR CASH PAY & OUT-OF-NETWORK PATIENTS

 You are entitled to receive a “Good Faith Estimate” (GFE) that outlines the anticipated costs of your medical care.

As required by Section 2799B-6 of the Public Health Service Act, healthcare providers must provide an estimate of charges for medical services and items to patients without insurance or those not using insurance. You should receive a written GFE at least one business day before your scheduled medical service or item. You also have the right to request a GFE from your provider (and any other provider) before arranging for any service or item. The GFE will reflect the total expected cost for non-emergency items or services, including related costs such as medical tests, prescriptions, equipment, and hospital fees.

The GFE provided will outline the anticipated charges for services at Metanoia Therapy based on the information available at the time. It does not account for any potential reimbursement from out-of-network benefits.

Please note that the GFE does not cover any unexpected or unforeseen costs that may arise during treatment. If complications or special circumstances occur, the actual cost may exceed the estimate. If you receive a bill that is more than $400 higher than your Good Faith Estimate, you have the right to dispute the charge. In that case, please contact Nimo Ali, the Owner of Optimum Behavioral Solutions, LLC, to discuss the discrepancy.

 For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.