Good Faith Estimate Disclaimer

In accordance with the No Surprise Act, Inspire Wellness has provided clients with costs for service (Good Faith Estimate) prior to initial appointment.  This Good Faith Estimate states the costs for service that are reasonably expected for your mental health care needs. The costs are based on information known at the time the estimate was created and in effect for the remainder of the calendar year or until new insurance is provided. 

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur.  If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may contact our billing team to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, there is a $25 fee for use and you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. 

 

For questions or more information about the No Surprise Act/ Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.