Good Faith Estimate Notice
Your Right to Receive a Good Faith Estimate
Under the No Surprises Act, health care providers are required to provide patients who do not have insurance or who are not using insurance to pay for their care with a Good Faith Estimate of the expected cost of services.
If you are uninsured or choose not to use insurance to pay for psychotherapy, you have the right to receive a Good Faith Estimate explaining the expected charges for your care.
You may ask me for a Good Faith Estimate before scheduling a service. If you schedule services at least three business days in advance, you are generally entitled to receive a Good Faith Estimate within the timeframes established by federal law.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you may be eligible to dispute the bill through the federal patient-provider dispute resolution process.
Please keep a copy of your Good Faith Estimate for your records.
For questions or to request a Good Faith Estimate, please contact:
Dr. Ronna Milo Haglili, PsyD
Clinical Psychologist
California License PSY 33032
ronna.mh.psyd@gmail.com
(650) 762-5869