Notification of the No Surprises Act and Good Faith Estimates

“Hello! Welcome to Lifespan Wellness Marriage & Family Therapy!

The No Surprises Act established new protections and disclosure requirements against surprise medical billing that takes effect on January 1, 2022.

Part I of the regulation protects consumers with health plan coverage from surprise bills from out-of-network providers under limited circumstances related to emergency and non-emergency services at in-network facilities.

Part II of the no surprises billing regulations requires that all health care providers and health care facilities that are licensed, certified, or approved by the state to provide Good Faith Estimates of expected charges for services and items offered to uninsured, out-of-network, and self-pay consumers before services are rendered. 

The Good Faith Estimate includes all the following:
  • Client name
  • Client date of birth
  • Description of the services that will be provided
  • Itemized list of goods or services reasonably expected to be provided in connection with the scheduled services
  • Diagnostic codes, service codes, and expected charges associated with each of those goods or services
  • Provider name, NPI, and tax ID number
  • Office location where services will be provided
What Consumers Also Need To Know

The provider may recommend additional items or services as part of the treatment that are not reflected in the original estimate, and a separate or updated Good Faith Estimate will be provided. Estimates for psychotherapy sessions are made based on fees per session multiplied by approximate time periods for services, so estimated costs can differ based on how long services are engaged. While it is not possible to know in advance how many sessions may be necessary or appropriate for a person’s treatment, the Good Faith Estimate provides an estimate of the service costs using the fees and approximate, but not required, treatment periods. 

The Good Faith Estimate does not obligate or require the client to obtain any of the listed services from the provider or continue services for the duration of the time periods indicated on the estimate. The Good Faith Estimate is simply to help clients who are uninsured or not using insurance calculate projected costs of services for the approximate time that services may be rendered.

What You Will See When You Visit The Office

Per the requirements, this notification of the Good Faith Estimate will also be displayed in the office:

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for health care, medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your service or 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

For questions or more information about your right to a Good Faith Estimate, call 800-MEDICARE (800-633-4227) or visit: www.cms.gov/nosurprises

Contact Us

Lifespan Wellness Marriage and Family Therapy adheres to all New York State laws and regulations and also values your privacy and confidentiality. If you are interested in the services offered please call 917-913-6441 to receive your free telephone screening and schedule your appointment.

If you contact Lifespan by email please be advised that emails must only contain your name, telephone number, the services you are interested in, and best times to contact you. Responses will be provided within within 24 hours.

Please note that visiting this site or contacting Maria Constantinou by email or telephone does not constitute or establish a professional or therapeutic relationship. In cases of emergency, please call 911 or go directly to your nearest emergency room.

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Location: 41-02 Bell Boulevard, 2nd Floor, Bayside, NY 11361

Office Hours: By Appointment

Tel: 917-913-6441

For general inquiries please send emails to lifespanwellnessmft@gmail.com

For correspondences pertaining to medical or other confidential information please send emails to lifespanwellnessmft@hushmail.com