Good Faith Estimate Notice

You have the right to receive a Good Faith Estimate of expected charges

If you do not have health insurance, or you choose not to use your insurance to pay for care, you generally have the right under the federal No Surprises Act to receive a Good Faith Estimate of the expected charges for your care.

Harmony Mindful Breakthrough Specialists (HarmonyMBS) will provide a Good Faith Estimate when you request one, or when you schedule an eligible service at least three business days in advance. You may request an estimate before scheduling. The estimate is provided in writing and describes the expected charges for the items and services reasonably anticipated for your care. It is not a bill and does not require you to receive care.

When will I receive my estimate?

If you schedule care 3–9 business days in advance, the estimate is generally provided within one business day after scheduling.
If you schedule care 10 or more business days in advance, the estimate is generally provided within three business days after scheduling.
If you request an estimate without scheduling, it is generally provided within three business days of your request.

To request an estimate, contact HarmonyMBS using the contact information on our website. You can ask for a paper or electronic copy. Keep your estimate for your records and compare it with any bill you receive.

If your bill is higher than the estimate

If a bill from a provider or facility is at least $400 more than that provider’s or facility’s Good Faith Estimate, you may be eligible to dispute the charges through the federal patient-provider dispute resolution process. Generally, you must start that process within 120 calendar days of the date on your initial bill.

This notice explains your federal rights and does not replace an individualized Good Faith Estimate for your particular care.