Good Faith Estimate - No Surprises Act
Your Right to a Good Faith Estimate
Under the federal No Surprises Act (effective January 1, 2022), you have the right to receive a "Good Faith Estimate" of expected charges for counseling services if you are:
• Uninsured, OR
• Insured but choosing not to use your insurance for services (self-pay) This requirement helps ensure transparency and predictability in healthcare costs. What is a Good Faith Estimate?
A Good Faith Estimate is an estimate of the total expected cost of counseling services. It includes:
• The expected charges for services
• The anticipated frequency of sessions
• The expected duration of treatment
Important: This is an estimate, not a contract. Actual costs may vary based on your treatment needs and progress.
How to Receive Your Good Faith Estimate
Your personalized Good Faith Estimate will be provided to you in writing during your free consultation call or before your first scheduled session.
Your estimate will include:
• Your individual session rate
• The anticipated number and frequency of sessions (typically projected for 12 months) • The total estimated cost based on your projected treatment plan
Session Rate Structure
Session fees are determined on an individual basis during your free consultation. Factors considered include your financial situation, treatment needs, and insurance status. We believe cost should not be a barrier to accessing quality mental health care.
Typical Treatment Projections
Most clients attend therapy on a weekly, bi-weekly, or monthly basis. The frequency of sessions will be determined based on your individual needs and goals, which we will discuss together during your consultation.
Your personalized Good Faith Estimate will reflect your specific treatment plan and session frequency.
When Estimates May Change
A new or updated Good Faith Estimate will be provided if:
• Your treatment plan changes significantly
• Your session frequency changes
• Your session rate changes
• 12 months have passed since your last estimate
You will be notified in advance if any changes will affect your costs.
Your Right to Dispute a Bill
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the charge through a federal patient-provider dispute resolution process.
To initiate a dispute:
• You must start the dispute within 120 days of the date on your bill
• There is a $25 fee to use the dispute process
• Visit www.cms.gov/nosurprises or call (800) 368-1019 for more information and to obtain the dispute form
Important: Keep a copy of your Good Faith Estimate in a safe place. You may need it if you wish to dispute a bill.
Questions?
If you have questions about fees or your Good Faith Estimate, please don't hesitate to ask during your free consultation. I am committed to transparency and want you to feel fully informed about the financial aspects of your care.
This notice is provided in compliance with the federal No Surprises Act (HR133, Title 45 Section 149.610).
