No Surprises Act/Good Faith Estimate

The Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. This includes mental health or medical needs. The estimate provided to you by Dando Luz Wellness Collective, is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. This estimate does not take into consideration the client’s insurance deductible, co-payment, or coinsurance amounts.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

 If you are billed for more than $400 more than your Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill or ask if there is financial assistance available.

 For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059.