Good Faith Estimate for Services
Recentered Relationship Therapy, LLC
2150 W. 29th Ave. Suite 125
Denver, CO 80211
Your Rights and Protections Against Surprise Medical Bills
Under the No Surprises Act, effective January 1, 2022, you have the right to receive a "Good Faith Estimate" of expected charges for mental health services from your healthcare provider.
What is a Good Faith Estimate?
A Good Faith Estimate shows the expected costs of items or services from your therapist. This estimate is based on information known at the time the estimate is created and is subject to change based on your specific circumstances and the course of treatment.
When Will You Receive This Estimate?
You can request a Good Faith Estimate before you schedule a service, or at any time during your therapy treatment. Please note, it is required to collect your name and date of birth to provide your estimate. We will be unable to provide you with an estimate promptly until this information is provided. Once we receive this information, you will receive a Good Faith Estimate:
Before you schedule a service, upon request
No later than 1 business day after you schedule a service
No later than 3 business days after you request an estimate for a service that is scheduled at least 10 business days in advance
No later than 1 business day after you request an estimate for a service scheduled at least 3 business days but fewer than 10 business days in advance
A Good Faith Estimate (GFE) is an estimate only. Your actual charges may differ from the GFE you receive based on:
Changes in your treatment plan
The number of sessions you attend
Cancellations and no-shows (subject to our cancellation policy)
Additional services you may request
The progress of your treatment
Your Rights Under Federal Law
Right to a Good Faith Estimate
You have the right to receive this Good Faith Estimate of expected costs.
Dispute Resolution Process
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through a federal dispute resolution process.
Timeline for disputes:
You must start the dispute process within 120 calendar days of the date on the bill
You can contact the U.S. Department of Health and Human Services (HHS) at 1-800-985-3059 or visit www.cms.gov/nosurprises for more information
Additional Information
For more information about your rights under federal law, visit:
Call 1-800-985-3059
For questions or concerns about this estimate, contact:
1-800-985-3059
Recentered Relationship Therapy, LLC
2150 W. 29th Ave. Suite 125
Denver, CO 80211
Email: Sara@recenteredrelationshiptherapy.com
Phone: 970-616-0590
Website: https://www.recenteredrelationshiptherapy.com/
Questions? If you have any questions about this Good Faith Estimate or about the cost of your care, please contact us. We are here to help you understand your expected costs and answer any questions you may have about your treatment.