Notice for Uninsured and Self-Pay Clients
Under the federal No Surprises Act, Connections Counseling Services, LLC provides Good Faith Estimates to individuals who are uninsured or who choose not to use health insurance for their care.
What Is a Good Faith Estimate?
A Good Faith Estimate provides an estimate of the expected charges for scheduled health care services. It is not a bill and does not guarantee the final amount you will be charged.
Who Receives a Good Faith Estimate?
You may receive a Good Faith Estimate if you:
- Do not have health insurance; or
- Have health insurance but choose not to use it for your services.
You may also request a Good Faith Estimate before scheduling services.
How We Provide Your Estimate
When applicable, we will provide a written Good Faith Estimate within the timeframes required by federal law. Estimates may be provided electronically or in another permitted format.
Your estimate will identify the services expected to be provided and the expected charges associated with those services.
For Connections Counseling Services, estimates may include psychotherapy sessions, assessments, or other services you schedule with us.
Your Right to Dispute a Bill
If you receive a bill from Connections Counseling Services that is at least $400 more than the amount estimated for that provider, you may have the right to dispute the bill through the federal patient-provider dispute resolution process.
The dispute process has specific eligibility requirements and deadlines. More information is available through the federal No Surprises Help Desk at 1-800-985-3059.
Request a Good Faith Estimate
If you are uninsured or choosing not to use insurance and would like a Good Faith Estimate, contact us:
Connections Counseling Services, LLC
Email: contact@connections-counseling.org
Phone: (407) 346-4504
We will provide the estimate in accordance with applicable federal requirements.
Important
A Good Faith Estimate reflects expected charges based on the information available when the estimate is prepared. Your actual care may differ from what was anticipated, and additional services may result in additional charges. CMS specifically notes that an estimate may not include services that could not reasonably have been anticipated when it was prepared.