top of page

Good Faith Estimate

This statement was last updated on August 29, 2026.

  • Under the new law, the “No Surprise Act 2022,” health care providers need to give clients who do not have insurance or who are not using insurance an estimate of the costs for medical items and counseling services at Lighting Fires Counseling, PLLC

  • You have the right to receive a Good Faith Estimate for the expected cost of any non-emergency items or services. This includes related costs like counseling services or testing.

  • We will make sure you receive a Good Faith Estimate in writing or electronically before your medical service or item. 

  • There may be additional items or services the convening provider or convening facility recommends as part of the course of care that must be scheduled or requested separately and are not reflected in the Good Faith Estimate. 

  • If your needs change during treatment, your provider should supply a new, updated Good Faith Estimate to reflect the changes to treatment and the accompanying cost changes.

  • The information provided in the Good Faith Estimate is only an estimate and actual items, services, or charges may differ from the Good Faith Estimate.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. The initiation of a patient-provider dispute resolution process will not adversely affect the quality of your care. 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.

  • The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) client to obtain the items or services from any of the providers or facilities identified in the Good Faith Estimate.

  • You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

  • There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

  • To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 985-3059.

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

  • Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.

  • For questions, more information, or to file a complaint about your rights go to: www.cms.gov/nosurprises.

bottom of page