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Good Faith Estimate Notice

For more information about your right to a Good Faith Estimate or how to dispute a bill, visit: No Surprise Billing | CMS

Right to Receive a Good Faith Estimate

Under the No Surprises Act, healthcare providers are required to give clients who do not have insurance or who are not using insurance an estimate of the expected charges for medical items and services.

What This Means for You

If you are a private-pay client or are choosing not to use insurance for services at Coastal Collaborative Care, you are entitled to receive a Good Faith Estimate (GFE) that outlines the anticipated costs of your services.

  • Your GFE is based on information known at the time it is created and is not a contract or a guarantee of treatment or fee totals. Your actual costs may vary depending on the services you receive.
  • You may request a GFE at any time — before you schedule, when you schedule, or at any point during your care.
If You Receive a Bill Higher Than Your Estimate

If you receive a bill that is at least $400 more than the amount listed on your Good Faith Estimate:
You have the right to dispute the bill.

You may contact the provider or practice to discuss the bill, request an updated Good Faith Estimate, or negotiate the charges. You can also initiate a dispute with the U.S. Department of Health & Human Services.

Contact Us

Email: admin@coastalcollaborativecare.com

Telephone: 571-249-5332

Coastal Collaborative Care LLC

Coastal Collaborative Care

Address

We provide telehealth and in-person therapy. In-person offices are located in Old Town North Alexandria, VA, Downtown Norfolk, VA. and Fredericksburg, VA.

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