Your Right to a Good Faith Estimate

Under the No Surprises Act, you have the right to receive a Good Faith Estimate explaining the expected cost of your healthcare services.

Gray Matters Therapy & Consulting, LLC is a private-pay practice and does not accept or bill health insurance directly. Clients are responsible for payment at the time of service. Upon request, we can provide a superbill that clients may submit to their insurance company for possible out-of-network reimbursement. Reimbursement is not guaranteed and depends on the client’s insurance plan.

Under the federal No Surprises Act, individuals who do not have health insurance or who are not using insurance to pay for their services have the right to receive a Good Faith Estimate outlining their expected healthcare costs before receiving care.

Your rights include:

• You have the right to receive a Good Faith Estimate for the expected cost of your healthcare services.
• If you schedule services at least three business days in advance, you generally must receive a written Good Faith Estimate within the timeframes required by federal law.
• You may request a Good Faith Estimate before scheduling services.
• Your Good Faith Estimate will describe the expected services and associated charges. It is an estimate, not a bill or guarantee of the final cost.
• If you receive a bill that is at least $400 more than the Good Faith Estimate from the same provider, you may be eligible to dispute the bill through the federal patient-provider dispute resolution process.

Keep a copy of your Good Faith Estimate so you can compare it with any bills you receive.

For questions about your Good Faith Estimate or to request one, contact:

Gray Matters Therapy & Consulting, LLC

Email: m.gray@graymatterstc.com
Phone: 617-229-7438

For more information about your rights, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.