No Surprises Act Notice

Under the No Surprises Act, you have the right to receive a “Good Faith Estimate” of the expected charges for your mental health services.

What is a Good Faith Estimate?

A Good Faith Estimate is a written document that shows the expected costs for mental health services, including:

• Therapy session fees
• Diagnostic assessments (if applicable)
• Any other services that may be provided as part of your treatment

The estimate is based on information known at the time it is created and may change based on your specific needs and treatment plan.

You have the right to request and receive a Good Faith Estimate if you:

• Do not have health insurance, or
• Have health insurance but choose not to use it (self-pay), or
• Are seeking services that are not covered by your insurance

Even if you have insurance, you can always ask for a Good Faith Estimate to understand potential out-of-pocket costs.

Before Scheduling:

You may request a Good Faith Estimate before scheduling your first appointment. Contact us at:

• Email: hello@wearebethesdatherapy.com
• Phone: (240) 389-0027

After Scheduling:

If you have already scheduled an appointment, we will provide your Good Faith Estimate in accordance with federal law requirements (typically at least 1 business day before your scheduled service, or at least 3 business days in advance for services scheduled more than 10 days in the future).

What to Do with Your Estimate:

• Keep a copy or take a photo of your Good Faith Estimate for your records
• Review it carefully and ask questions if anything is unclear
• Compare the estimate to your actual bill after receiving services

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

How to Dispute a Bill:

1. Contact us first: Reach out to hello@wearebethesdatherapy.com or call (240) 389-0027 to discuss the difference
2. Initiate a dispute: If we cannot resolve the issue, you can start a dispute resolution process
3. Timeline: You must initiate the dispute within 120 days of receiving the bill

Patient-Provider Dispute Resolution:

For information about the federal dispute resolution process, visit:

• Website: www.cms.gov/nosurprises
• Phone: No Surprises Help Desk at (800) 985-3059

The No Surprises Act protects you from certain unexpected charges in emergency and non-emergency situations.

Emergency Services:

If you receive emergency mental health care, you can only be billed at in-network rates, even if:

• The provider is out-of-network with your insurance
• You receive care at an out-of-network facility
• You did not have time to get prior authorization

Note: Bethesda Therapy provides scheduled teletherapy services only. We do not provide emergency services. If you are experiencing a mental health emergency, please call 988 (Suicide & Crisis Lifeline) or 911.

Services at In-Network Facilities:

If you receive services at an in-network facility from an out-of-network provider, you are protected from balance billing unless:

• You were given written notice at least 72 hours in advance
• You gave written consent to be billed by the out-of-network provider

Balance Billing:

When a provider bills you for the difference between what your insurance pays and the provider’s full charge.

Out-of-Network Provider:

A healthcare provider who does not have a contract with your health insurance plan.

In-Network Provider:

A healthcare provider who has a contract with your health insurance plan to provide services at negotiated rates.

Good Faith Estimate:

A written estimate of expected charges for scheduled healthcare services for uninsured or self-pay patients.

You have the right to:

• Receive a Good Faith Estimate of costs before receiving services
• Be billed at in-network rates for emergency services, even from out-of-network providers
• Choose your provider and be informed about their network status
• Dispute unexpected bills that are significantly higher than your Good Faith Estimate
• Not be charged for the difference between what your insurance pays and the provider charges (balance billing) in certain situations

Contact Bethesda Therapy:

• Email: hello@wearebethesdatherapy.com
• Phone: (240) 389-0027

Contact the No Surprises Help Desk:

• Website: www.cms.gov/nosurprises
• Phone: (800) 985-3059

For More Information:

For detailed information about your rights under the No Surprises Act, visit the Centers for Medicare & Medicaid Services (CMS) website at www.cms.gov/nosurprises.

Please also review our related policies:

• Privacy Policy
• Terms of Service
• Cookie Policy