Good Faith Estimate Notice

Your Right to a Good Faith Estimate

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

If you are uninsured, self-pay, or choosing not to use insurance, Empower You Mental Health & Wellness will provide you with a Good Faith Estimate of expected charges for services, upon request or when you schedule services.

• You have the right to receive a Good Faith Estimate in writing at least 1–3 business days before your scheduled service.
• The estimate will include all reasonably expected charges for services such as evaluations, therapy, coaching, memberships, labs, testing, and wellness services.
• You may request a Good Faith Estimate at any time, even before scheduling a service.

For questions or to request a Good Faith Estimate, please contact us at: