Your Rights Under the No Surprises Act

Last Updated: February 25, 2026

Effective January 1, 2022, the No Surprises Act (Public Law 116-260) gives patients who do not have insurance or who choose not to use their insurance new protections against surprise medical bills. Under this law, healthcare providers and facilities are required to provide patients with a Good Faith Estimate of expected charges for scheduled services.

What Is a Good Faith Estimate?

A Good Faith Estimate (“GFE”) is a written estimate of the total expected cost of non-emergency healthcare services, including mental health services such as psychotherapy. The GFE is designed to help you understand the expected cost of your care before you receive services, so you can make informed decisions about your treatment.

Who Is Entitled to a Good Faith Estimate?

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

• You do not have health insurance, or
• You choose not to use your health insurance for therapy services (self-pay)

This right applies to all patients who are uninsured or who elect to pay out of pocket for services, regardless of the reason.

What Does a Good Faith Estimate Include?

A Good Faith Estimate includes:

• A list of each item or service you are expected to receive, along with the corresponding diagnosis codes (if applicable)
• The expected charges for each item or service
• The name and National Provider Identifier (NPI) of the provider furnishing each service
• The expected date(s) of service, if known
• The healthcare facility or location where services will be provided

For recurring services such as ongoing psychotherapy, the Good Faith Estimate will include the expected charges for the initial period of treatment, as well as the expected frequency and duration of services.

When Will You Receive a Good Faith Estimate?

You are entitled to receive a Good Faith Estimate:

• When you schedule a service at least 3 business days in advance, the estimate must be provided within 1 business day of scheduling
• When you schedule a service at least 10 business days in advance, the estimate must be provided within 3 business days of scheduling
• Upon request at any time, even if you have not yet scheduled a service

Your Right to Dispute a Bill

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through an independent patient-provider dispute resolution process. Specifically:

• You may initiate the dispute resolution process within 120 calendar days of the date of the original bill
• The dispute resolution process is administered by the U.S. Department of Health and Human Services (HHS)
• You may be required to pay a small administrative fee to initiate the dispute
• A determination will be made by a Selected Dispute Resolution (SDR) entity within 30 business days of receiving all necessary information

To start the dispute resolution process, you may contact:

Centers for Medicare and Medicaid Services (CMS) Phone: 1-800-985-3059 Website: https://www.cms.gov/nosurprises

Make sure to save a copy of your Good Faith Estimate. If you are billed a higher amount, you will need the estimate to support your dispute.

Important Information for Insured Clients

Most clients at POM Therapy Collective use health insurance for therapy services through the Headway platform. If you are using insurance to pay for your services:

• Your insurance company is responsible for providing you with an Explanation of Benefits (EOB) that details the costs of your services and what your plan covers
• Your out-of-pocket costs (copays, coinsurance, and deductibles) are determined by your insurance plan and may vary
• The Good Faith Estimate provisions of the No Surprises Act apply specifically to uninsured and self-pay patients
• If you have questions about your insurance coverage or out-of-pocket costs, please contact your insurance company directly or review your plan documents

Even if you have insurance, you always have the right to choose to pay out of pocket for services. If you choose to self-pay, you are entitled to a Good Faith Estimate as described above. Please let us know before your appointment if you wish to self-pay rather than use your insurance.

Limitations of the Good Faith Estimate

Please be aware of the following:

• The Good Faith Estimate is an estimate, not a contract or guarantee of final charges
• Actual charges may differ from the estimate if your treatment plan changes, if additional services become necessary, or if circumstances change
• The estimate does not include charges for unanticipated services that may be recommended during the course of treatment
• If additional services are recommended beyond those included in the original estimate, you have the right to receive an updated Good Faith Estimate

How to Request a Good Faith Estimate

To request a Good Faith Estimate for therapy services at POM Therapy Collective, please contact us:

POM Therapy Collective Sukhi Sandhu, MS, LCPC Email: sukhi@pomtherapycollective.com Phone: (224) 497-2893

You may also request a Good Faith Estimate before scheduling a service to help you evaluate and compare costs.

For more information about your rights under the No Surprises Act, visit https://www.cms.gov/nosurprises.