Forms
Lakeshore Psychology Group Forms
Click on the form below for a downloadable pdf
Good Faith Estimates
Effective January 2022, you have the right to receive a “Good Faith Estimate” explaining how much your healthcare services will cost. Under the law, healthcare providers (including mental health providers) need to give patients, who do not have insurance or who are not using insurance, an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any nonemergency items or services
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider and any other provider you choose for a Good Faith Estimate before you schedule an item or service
- If you receive a bill that is at least $400 more than your Good Faith Estimate you can dispute the bill
- Make sure to save a copy or picture of your Good Faith Estimate
For questions or more information about your right to a Good Faith Estimate visit www.cms.gov/nosurprises or call 1-800-985-3059