Ley contra facturas sorpresa (Estimado de buena fe) — resumen en español
Bajo la ley federal No Surprises Act, usted tiene derecho a recibir por escrito un Estimado de Buena Fe (Good Faith Estimate) con los costos esperados de su tratamiento. Si la factura final supera el estimado por $400 o más, usted puede disputarla a través del proceso federal de resolución de disputas dentro de 120 días. Para preguntas sobre su estimado o para iniciar una disputa, llame al (626) 354-6440 o visite cms.gov/nosurprises. La versión legal vinculante está en inglés.
Your Right to a Good Faith Estimate
Effective date: [TBD]. Last updated: [TBD].
You have the right to receive a Good Faith Estimate explaining how much your medical care will cost.
What a Good Faith Estimate is
Under the federal No Surprises Act (Consolidated Appropriations Act, 2021, codified at 42 U.S.C. § 300gg-111 et seq.; 26 U.S.C. § 9816; 29 U.S.C. § 1185e; implemented at 45 C.F.R. § 149.610), health-care providers must give patients who are uninsured or who do not plan to use insurance a written "Good Faith Estimate" of expected charges for non-emergency medical items and services, including psychotherapy.
What you can expect
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services or items, including any related fees.
- Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service or item.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or to dispute
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059. For local questions, contact our billing office: billing@pasadenaclinicalgroup.com · (626) 354-6440.
How we provide your estimate
For self-pay clients, the Practice provides a written Good Faith Estimate at intake and before the first session, in accordance with 45 C.F.R. § 149.610. The estimate is based on the clinical work as understood at that time. If the scope of treatment changes substantially, an updated estimate is provided. Estimates are good-faith projections — actual charges may vary based on session length, frequency, and clinical course.
Patient–Provider Dispute Resolution (PPDR)
If you receive a final bill that exceeds your most recent Good Faith Estimate by $400 or more for the same provider and service, you may initiate the federal Patient–Provider Dispute Resolution process administered by the U.S. Department of Health and Human Services within 120 calendar days of the date of the bill. Information and forms are available at cms.gov/nosurprises. Initiating PPDR does not waive the Practice's right to pursue collection of undisputed amounts. The PPDR process is the exclusive federal mechanism for GFE-based disputes; the mediation and arbitration provisions of our Terms & Conditions do not apply to PPDR-eligible disputes while PPDR is available.
Limitation of liability
Nothing in this notice creates a private cause of action that does not otherwise exist under the No Surprises Act or its implementing regulations, and nothing here waives any defense, immunity, or limitation otherwise available to the Practice or any other Indemnified Party (as defined in our Terms & Conditions). Disputes outside the federal PPDR process are governed by Sections 9, 10, and 11 of our Terms.