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Good Faith Estimate

Federal law generally gives individuals who are uninsured or choosing not to use insurance the right to receive a Good Faith Estimate (GFE) of expected healthcare costs. This page explains what a GFE is, when it applies, and your rights regarding estimated charges.

Effective Date: August 1, 2026
 
Your Rights Under the No Surprises Act
A Good Faith Estimate (GFE) explains the expected cost of healthcare services before you receive them. If you are uninsured or choose not to use your health insurance, you have the right to receive a GFE of the expected charges for your care.
 
The estimate is based on the information available at the time it is created and does not include unknown or unexpected costs that may arise during treatment.
 
If Your Treatment Changes
Throughout treatment, your treatment plan or recommended services may change based on your individual needs. If additional services are recommended or the expected cost of care changes significantly, an updated GFE may be provided.
 
This Estimate Is Not a Contract
A GFE is not a contract and does not require you to receive services from Still Bloom Counseling & Wellness. It is intended to help you understand the anticipated cost of your care.
 
If You Receive a Higher Bill
If you are billed $400 or more above your GFE, you may be eligible to dispute the bill through the federal patient-provider dispute resolution process.
 
Before beginning the dispute process, you may wish to contact Still Bloom Counseling & Wellness to:
 

  • Request that the bill be updated to match your GFE.

  • Discuss or negotiate the bill.

  • Ask questions about the charges.
     

You may also begin the federal patient-provider dispute resolution process through the U.S. Department of Health and Human Services (HHS). The dispute process generally must be started within 120 calendar days of the date on the original bill and requires an administrative fee.
 
For more information about Good Faith Estimates or the patient-provider dispute resolution process, visit the Centers for Medicare & Medicaid Services (CMS) or call (800) 985-3059.
 
Questions
If you have questions about the Good Faith Estimate, please contact:
 
Still Bloom Counseling & Wellness
Jaycie Westphal, LPC
 
Phone: (920) 525-1266
Email: connect@stillbloomtherapy.com

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