Effective date: September 22, 2026
01You have the right to receive a Good Faith Estimate explaining how much your care will cost
Under the law, health care providers must give patients who don't have insurance, or who aren't using insurance, an estimate of the expected charges for 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 services. This includes related costs like tests, prescription drugs, equipment, and facility fees.
You can ask us for a Good Faith Estimate before you schedule an item or service. If you schedule an item or service at least three business days in advance, we will give you a Good Faith Estimate in writing within one business day of scheduling. If you schedule at least ten business days in advance, you will receive it within three business days. If you simply ask for one, you will receive it within three business days of the request.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask any provider for one before you schedule.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You have 120 days from the date on the bill to start the patient-provider dispute resolution process. While a dispute is pending, we will not move your bill to collections or charge you late fees.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-985-3059.
02How this works at MindForge
MindForge does not bill insurance. Every patient here is a self-pay patient, so every patient is entitled to a Good Faith Estimate, and we would rather you have one than not.
- Ask any time. Call (214) 730-6463 or email info@mindforge.health and ask for a Good Faith Estimate. You do not have to be scheduled, and you do not have to explain why.
- What it will include: your name and date of birth; a description of the primary item or service and the date we expect to provide it; an itemized list of the items and services we reasonably expect, with the diagnosis and service codes and expected charges for each; and a list of any other providers or facilities we expect to be involved, with instructions for getting estimates from them.
- An estimate is an estimate. It reflects what we reasonably expect at the time we write it. If your care changes, we will give you an updated estimate before the change takes effect where we can.
- If you use a superbill to seek reimbursement from your own insurer, what they ultimately pay you is between you and them. The Good Faith Estimate describes what we expect to charge.
Questions: 5301 Alpha Rd, Suite A-10, Dallas, TX 75240 · (214) 730-6463 · info@mindforge.health