No Surprises Act & Good Faith Estimates
At DBT Institute of Central Illinois (DBTICI), we are committed to transparency in the cost of your care. The No Surprises Act, a federal law that took effect on January 1, 2022, helps protect patients from unexpected medical bills and gives many individuals the right to receive a Good Faith Estimate of the expected cost of healthcare services.
What is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written estimate of the expected charges for healthcare services. It is intended to help you understand the anticipated cost of your care before you receive services.
For psychotherapy services, your Good Faith Estimate may include the expected costs of:
Initial intake evaluations
Individual psychotherapy sessions
Group therapy or DBT skills training
Family therapy sessions
Other services that are reasonably expected as part of your treatment
Because mental health treatment is individualized, the number and frequency of sessions may change over time. Your estimate is based on the information available at the time it is prepared and is not a guarantee of the final cost of treatment.
Who Can Receive a Good Faith Estimate?
You have the right to receive a Good Faith Estimate if you are:
Uninsured, or
Choosing not to use your health insurance to pay for services (self-pay)
A Good Faith Estimate is available upon request before scheduling services or at any time during your treatment.
Your Rights Under the No Surprises Act
Under federal law:
You have the right to receive a Good Faith Estimate of expected charges before receiving services.
You may request a Good Faith Estimate 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.
Additional information about your rights under the No Surprises Act is available through the Centers for Medicare & Medicaid Services (CMS).
Please Note
A Good Faith Estimate:
Is an estimate only—not a contract.
Does not obligate you to begin or continue treatment.
Does not guarantee insurance coverage or reimbursement.
May change if your treatment needs, frequency of services, or treatment plan changes.
If your treatment changes substantially, you may request an updated Good Faith Estimate.
How to Request a Good Faith Estimate
If you would like a Good Faith Estimate or have questions about our fees, insurance participation, or payment options, please contact our office before your appointment.
DBT Institute of Central Illinois
Email: info@dbtici.com
Contact Form: https://dbtici.com/contact
We are happy to discuss the expected cost of treatment and help you make an informed decision about your care.
Notice Required by Federal Law
You have the right to receive a "Good Faith Estimate" explaining how much your medical and mental health care will cost.
Under the law, healthcare providers must give patients who are uninsured or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services.
You may ask your healthcare provider for a Good Faith Estimate before you schedule a service or at any time before or during treatment.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute the bill.
Be sure to save a copy or photo of your Good Faith Estimate.
For more information about your rights, visit www.cms.gov/nosurprises.