Good Faith Estimate Notice

Causeway Behavioral Health Services, PLLC

Your Right to Know the Expected Cost of Care

If you are uninsured or are not using insurance to pay for your care, you generally have the right to receive a written Good Faith Estimate of expected healthcare charges.

You may request an estimate before scheduling an appointment. The estimate describes the services reasonably expected and their anticipated costs.

When You Will Receive Your Estimate

• For care scheduled 3–9 business days in advance, your estimate will be provided within 1 business day after scheduling.

• For care scheduled 10 or more business days in advance, your estimate will be provided within 3 business days after scheduling.

• If you request an estimate before scheduling, it will be provided within 3 business days of your request.

Understanding Your Estimate

An estimate reflects the information available when it is prepared. Your treatment needs may change, and additional services may be recommended. You may request an updated estimate.

Services from other providers, including pharmacy services and laboratory testing, may have separate charges.

If Your Bill Is Higher Than Expected

If charges from a provider or facility are at least $400 above that provider’s or facility’s estimate, you may qualify for the federal patient-provider dispute resolution process.

Keep your written estimate so you can compare it with your bill.

Questions or Requests

Contact Causeway Behavioral Health Services, PLLC:

Phone: (252) 659-5133
Email: info@causewaybhs.com

Please do not send medical details through general email.

For more information about Good Faith Estimate rights and billing disputes, visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059.