Shanaz Ikonne, PLLC
Good Faith Estimate & Dispute Process Disclaimer
Transparency in fees and charges is an important part of the therapeutic relationship. In accordance with the No Surprise Act, Shanaz Ikonne, PLLC provides Good Faith Estimates to all clients. The Good Faith Estimate shows the cost of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.
The Good Faith Estimate does not include any unknown or unexpected costs that might arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. Ultimately, Shanaz Ikonne, PLLC prioritizes collaborating with clients to create a treatment plan that meets the client's emotional needs with clear communication about treatment costs which will be discussed frequently and often based on client's need for therapeutic services. Frequency and duration of sessions are an ongoing and open conversations are welcomed. You will be provided with a verbal and written estimate. Please note you are responsible for keeping your copy of the estimate.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may contact the health care provider or facility to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date of the original bill.
There is a $75 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 368-1019.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019.