Your Rights Against Surprise Medical Bills

Under the No Surprises Act, you have protections against unexpected medical bills in certain situations. This notice explains those rights.

Emergency Services

If you have a medical emergency, you have the right to receive emergency services from any provider or facility, even if they are not in your health plan's network, without obtaining prior authorization and without paying more than your in-network cost-sharing amount.

Non-Emergency Services at In-Network Facilities

When you receive non-emergency care at an in-network facility, you have the right to be protected from surprise billing if out-of-network providers are involved in your care without your knowledge. In these cases, out-of-network providers may not bill you more than your in-network cost-sharing amount unless you provide informed written consent and waive your protections.

Out-of-Network Provider Disclosures

If Mood and Motion Therapy is out of network with your insurance plan, we will provide information regarding your rights and financial responsibilities before services are provided when required by law.

Good Faith Estimates

Under federal law, healthcare providers are required to provide uninsured clients and clients who choose not to use their insurance benefits with a Good Faith Estimate of expected charges for healthcare services.

You have the right to receive a Good Faith Estimate explaining the anticipated cost of services before receiving care. The estimate will include reasonably expected charges for services provided by Mood and Motion Therapy.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill through the federal patient-provider dispute resolution process.

You may request a Good Faith Estimate before scheduling services or at any time prior to receiving care.

For more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises.

Questions and Complaints

If you have questions about your rights under the No Surprises Act, would like to request a Good Faith Estimate, or believe your protections have been violated, please contact us:

Mood and Motion Therapy
2150 Palomar Airport Road, Suite 209
Carlsbad, CA 92011

Phone: 760.237.0050
Email: info@moodandmotiontherapy.com
Website: moodandmotiontherapy.com

Last updated 6/5/2026