Good Faith Estimate & No Surprises Act
Effective Date: [21, September, 2026]
Last Updated: [21, September, 2026]
At BluePrint Mental Health, we believe patients should understand the expected cost of their care before receiving services. Because our practice operates on a self-pay basis, federal law provides certain protections to patients who do not have health insurance or who choose not to use their insurance for their care.
This page explains your rights under the No Surprises Act, including your right to receive a Good Faith Estimate (GFE) of expected charges for scheduled healthcare services.
What Is a Good Faith Estimate?
A Good Faith Estimate is a written estimate of the expected charges for healthcare items and services you are scheduled to receive.
A Good Faith Estimate is not a bill and is not a guarantee of the final amount you may owe. It is based on the information available to the provider when the estimate is prepared and generally reflects the services and charges that are reasonably expected at that time.
Unexpected healthcare needs, changes in treatment, additional services, or circumstances that were not reasonably anticipated when the estimate was prepared may result in charges that were not included in the original estimate.
Who Is Eligible for a Good Faith Estimate?
The federal Good Faith Estimate requirements generally apply to individuals who:
- Do not have health insurance; or
- Have health insurance but choose not to use it to pay for the healthcare services they receive.
Because BluePrint Mental Health operates as a self-pay practice, these requirements may apply to patients receiving services from our practice.
When Will I Receive a Good Faith Estimate?
You may request a Good Faith Estimate before scheduling care.
You should generally receive a Good Faith Estimate when you schedule a healthcare service at least 3 business days in advance.
Federal requirements generally provide the following timing:
- If services are scheduled 10 or more business days in advance: the Good Faith Estimate must generally be provided within 3 business days after scheduling.
- If services are scheduled 3–9 business days in advance: the Good Faith Estimate must generally be provided within 1 business day after scheduling.
- If you request an estimate before scheduling care: the provider must generally provide it within 3 business days after your request.
- If care is scheduled fewer than 3 business days in advance: the federal law generally does not require a Good Faith Estimate solely because of that scheduling timeframe; however, you may still request an estimate.
The applicable requirements and timing may vary based on the circumstances of your care.
What Information Is Included in a Good Faith Estimate?
A Good Faith Estimate generally includes an itemized list of the healthcare items and services that are reasonably expected to be provided, together with the expected charges.
Depending on the circumstances, the estimate may include information such as:
- Description of the healthcare service or item
- Expected quantity or frequency, when applicable
- Expected charge for each service or item
- Relevant provider or facility information
- Other information required under applicable federal regulations
A Good Faith Estimate is based on what is reasonably known when the estimate is prepared. Services provided by another provider or facility may be addressed separately when applicable.
What If My Care Changes?
A Good Faith Estimate is based on information available when it is prepared.
Your healthcare needs may change during the course of treatment. For example, your provider may determine that an additional visit, evaluation, treatment service, or other healthcare item is appropriate and was not reasonably expected when the original estimate was prepared.
Additional or separately scheduled services may therefore have charges that were not included in the original Good Faith Estimate.
We encourage you to ask questions about any proposed change in services or expected charges before receiving additional non-emergency services.
Is a Good Faith Estimate a Bill?
No.
A Good Faith Estimate is an estimate of expected charges. It is not a bill, statement of account, or guarantee of the final amount owed.
You should keep a copy of your Good Faith Estimate and compare it with any bill you receive.
What If My Bill Is Higher Than My Good Faith Estimate?
If you are uninsured or self-pay and your bill from a provider is at least $400 more than the expected charges stated in your Good Faith Estimate, you may have the right to dispute the bill through the federal Patient-Provider Dispute Resolution (PPDR) process.
Generally, you must meet the applicable federal eligibility requirements, including:
- You were uninsured or did not use your insurance for the service;
- You received the applicable healthcare service;
- You received a Good Faith Estimate;
- Your initial bill is at least $400 more than the expected charges from that provider or facility; and
- You initiate the federal dispute process within 120 calendar days from the date of the initial bill.
Eligibility requirements may change based on federal regulations and the circumstances of your care.
What Happens During the Dispute Process?
The federal Patient-Provider Dispute Resolution process allows an eligible uninsured or self-pay patient to have the disputed charges reviewed by an independent third party.
During the dispute process, the provider is subject to federal requirements regarding collection activity. For example, when a qualifying dispute is properly initiated, the provider generally may not move the disputed bill into collections, threaten collection, or charge late fees on the disputed amount while the dispute is pending.
Patients and providers may continue to communicate and negotiate regarding the bill during the process.
How Do I Start a Dispute?
If you believe you qualify to dispute a medical bill, you can obtain information and initiate the federal process through the Centers for Medicare & Medicaid Services (CMS).
The federal No Surprises Help Desk can also provide information about your rights and the dispute process.
No Surprises Help Desk:
1-800-985-3059
The federal dispute process is administered independently of BluePrint Mental Health.
You should keep copies of:
- Your Good Faith Estimate
- Your initial medical bill
- Relevant receipts or payment records
- Other documents related to the disputed charges
Can I Ask BluePrint Mental Health Questions About My Estimate or Bill?
Yes.
We encourage patients to contact us with questions about expected charges, Good Faith Estimates, billing statements, or changes in services.
BluePrint Mental Health
23410 Kingsland Blvd, Suite 200
Katy, Texas 77494
Phone: (832) 510-0690
Email: care@myblueprintmentalhealth.com
When contacting us, please do not include sensitive medical or psychiatric information in an unsecured email or general website contact form unless you have been specifically instructed to use that method.
Important Information About Emergencies
Good Faith Estimate requirements generally do not apply to emergency care.
BluePrint Mental Health is not an emergency or crisis service. Our website, email, and general contact form are not continuously monitored for emergencies.
If you are experiencing a psychiatric or medical emergency, believe you may be in immediate danger, or believe you may harm yourself or another person, call 911, go to the nearest emergency department, or call or text 988 for the Suicide & Crisis Lifeline.
Additional Information
The No Surprises Act is a federal law that provides protections for consumers against certain unexpected medical bills and establishes Good Faith Estimate requirements for uninsured and self-pay individuals.
The specific rights and requirements applicable to your situation depend on the services involved and the circumstances of your care.
For additional information about federal Good Faith Estimate and No Surprises Act protections, visit the official Centers for Medicare & Medicaid Services (CMS) resources.
Questions About Your Rights
If you have questions about your Good Faith Estimate, expected charges, or billing, please contact BluePrint Mental Health.
For questions about your federal rights under the No Surprises Act or the federal Patient-Provider Dispute Resolution process, you may contact the CMS No Surprises Help Desk at:
BluePrint Mental Health
23410 Kingsland Blvd, Suite 200
Katy, Texas 77494
Phone: (832) 510-0690
Email: care@myblueprintmentalhealth.com