No Limits Psychological Services, PLLC

No Limits Psychological Services, PLLCNo Limits Psychological Services, PLLCNo Limits Psychological Services, PLLC
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No Limits Psychological Services, PLLC

No Limits Psychological Services, PLLCNo Limits Psychological Services, PLLCNo Limits Psychological Services, PLLC
  • Home
  • About Us
  • Services
  • About ISTDP
  • For Patients
  • Forms
  • Contact Us

Patient Forms and Information

Please download the attachment pertaining to Good Faith Estimates. 


I will provide additional required forms directly to you prior to the first appointment.


Right to Receive a Good Faith Estimate of Expected Charges (pdf)Download

Good Faith Estimate and Surprise Medical Bills

As of January 1, 2022, federal healthcare laws have changed to protect consumers against unexpected medical charges/bills. 


You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost 


Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. 

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
     
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
     
  • 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 more information about your right to a Good Faith Estimate, visit
    www.cms.gov/nosurprises or call (210) 202-0100. 


**IF YOU DO NOT HAVE OR DO NOT PLAN TO USE INSURANCE, OR IF I AM OUT OF NETWORK, I WILL PROVIDE YOU A GOOD FAITH ESTIMATE PRIOR TO YOUR FIRST APPOINTMENT**
 

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