Good Faith Estimate

This notice relates to all clients who are NOT using health insurance for services.                

At the time that you schedule your initial appointment with us, our staff provides you with the specific costs of our services up front. Under the "No Surprises Act", which was implemented in January of 2022, you also have the right to receive a written “Good Faith Estimate” of your estimated out-of-pocket expenses for mental health services through Customized Behavioral Healthcare, LLC.

Our services are based on a specific hourly rate based on the provider's fee schedule, and are published on our website,  thus patients can anticipate costs up front. You can request a written Good Faith Estimate before you schedule or at any time during your treatment. While very unusual, if you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, call our office at 614-664-3175.

• Under the No Surprises Act, you have the right to receive a Good Faith Estimate explaining how much your mental health care is expected to cost if you do not have insurance or choose not to use insurance.        
• This estimate is not a bill. Actual charges may differ based on your clinical needs, service duration, or changes to the treatment plan.

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

• Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.   
• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.       
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.          
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.           
• Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.