Good Faith Estimate Notice

Last updated: May 15, 2025

You Have the Right to Receive a “Good Faith Estimate” Explaining How Much Your Medical Care Will Cost

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

Your Rights

• 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 (if applicable).

• You have the right to receive a Good Faith Estimate in writing at least 1 business day before your medical service or item.
  You can also ask me, or 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.

How This Applies at Cambium Counseling

As a client at Cambium Counseling, if you are uninsured or not using insurance, I will provide you with a Good Faith Estimate for the total expected cost of your counseling services. This estimate will be given to you in writing at least one business day before your scheduled appointment, or upon request.

Questions or More Information

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.

If you have questions about your estimate from Cambium Counseling, please contact:

Melissa Ryan
Email: melissa@cambiumcounseling.com
Phone: 970-235-0913

By engaging in services, you acknowledge that you have received and reviewed this Good Faith Estimate Notice.