Good Faith Estimate

Your Right to a Good Faith Estimate

Under federal law, you have the right to receive a Good Faith Estimate explaining the expected cost of your health care if you do not have health insurance or choose not to use your health insurance to pay for your care.

A Good Faith Estimate is not a bill. It is an estimate of the charges that are reasonably expected for your scheduled mental health services.

Who Is Eligible?

You generally have the right to receive a Good Faith Estimate if:

• You do not have health insurance; or
• You have health insurance but choose not to use it to pay for your services.

You may request a Good Faith Estimate before scheduling services or after an appointment or service has been scheduled.

Weave Mental Health Rates

Current standard session rates are:

• 60-Minute Session — $150
• 90-Minute Session — $225

Longer or other services may be available by arrangement. Your individual Good Faith Estimate will identify the services and expected charges applicable to your care.

Rates are subject to change. Any applicable changes will be communicated in accordance with practice policies.

What Will My Good Faith Estimate Include?

Your Good Faith Estimate will generally include:

• Your name and identifying information
• Provider information
• Description of the expected service
• Applicable service or billing codes when required
• Expected charge for each service
• Estimated frequency of services, when applicable
• Estimated total cost for the expected period of care
• Required federal notices and disclaimers

Because the length and frequency of mental health treatment can vary, your estimate will be based on the information reasonably known when the estimate is prepared.

A Good Faith Estimate does not require you to receive services from Weave Mental Health.

When Will I Receive My Estimate?

If you schedule services at least 3 business days in advance, you are generally entitled to receive a Good Faith Estimate within the timeframes established by federal law.

Generally:

• If services are scheduled 3–9 business days in advance, the estimate should be provided within 1 business day after scheduling.
• If services are scheduled 10 or more business days in advance, the estimate should be provided within 3 business days after scheduling.
• If you request an estimate before scheduling services, it should generally be provided within 3 business days of the request.

You may request a Good Faith Estimate at any time.

Mental Health Treatment Can Change

Mental health treatment is individualized.

The number, frequency, and type of sessions you receive may change depending on your needs, preferences, treatment goals, and clinical circumstances.

Because of this, your actual treatment costs may differ from the original estimate.

If the expected course of treatment changes significantly, an updated Good Faith Estimate may be provided when required or appropriate.

If Your Bill Is Higher Than Your Estimate

Keep a copy of your Good Faith Estimate.

If the amount billed by a provider is at least $400 more than the amount listed on the Good Faith Estimate from that provider, you may be eligible to use the federal Patient-Provider Dispute Resolution process.

This process allows an independent third party to review the bill and Good Faith Estimate and determine the appropriate amount you should pay.

Federal deadlines apply to starting a dispute, so you should review the current CMS requirements promptly if you believe you qualify.

Request a Good Faith Estimate

You may request a written Good Faith Estimate from Weave Mental Health before scheduling services or at any time during your care.

Weave Mental Health
Deanne Ford, LCSW
Phone: 208-969-0428
Email: Deanne@weavementalhealth.com
Twin Falls, Idaho

Additional Information

For additional information about your rights under the No Surprises Act, Good Faith Estimates, medical billing protections, or the Patient-Provider Dispute Resolution process, visit the official Centers for Medicare & Medicaid Services (CMS) Medical Bill Rights website.

Important Notice

This page provides general information regarding Good Faith Estimate rights under federal law.

Your actual Good Faith Estimate will be provided separately and will contain information specific to your anticipated services and expected charges.

The Good Faith Estimate is not a contract and does not require you to obtain the services listed in the estimate.