Good Faith Estimate

At Inclusive Speech & Language Services, we believe in clear, upfront communication about the cost of care—so you can make informed decisions with confidence.

Under the No Surprises Act, you have the right to receive a Good Faith Estimate explaining the expected cost of your care.

You can request an estimate for:

• Evaluations 
• Therapy sessions 
• Recommended services

Inclusive Speech & Language Services accepts insurance.

Your out-of-pocket cost will depend on:

• Your insurance plan 
• Deductibles 
• Copays or coinsurance 
• Authorization requirements 

We will help verify benefits when possible, but we cannot guarantee coverage or payment by your insurance provider.

• You may request a Good Faith Estimate at any time 
• You will receive estimates based on available information 
• If you are billed at least $400 more than your estimate, you may dispute the charges 

Visit: www.cms.gov/nosurprises 

To request a Good Faith Estimate, contact:

Inclusive Speech & Language Services, LLC

Inclusive Speech & Language Services, SLP, PLLC

contact@inclusivespeechtherapy.com

716-547-8255