Good Faith Estimate

I will provide a letter to you regarding a good faith estimate. Sample below.

The No Surprises Act

Congress has passed the No Surprise Billing Law to ensure consumers are

fully informed of potential fees when seeking treatment. According to the

interim rules, providers seeing fee for service patients are required to

provide a good faith estimate for treatment not to exceed 12 months.

I anticipate the cost of your treatment will be ______ per session for the

next 12 months as needed per clinical considerations unless we agree on

any change in the fee.