Good Faith Estimate

You have the right to receive a Good Faith Estimate explaining how much your care will cost.
Under the No Surprises Act (Section 2799B-6 of the Public Health Service Act), health care providers are required to provide patients who are paying out of pocket with a written Good Faith Estimate of expected costs before beginning services.

Who This Applies To
Because our practice does not accept insurance, this notice applies to all prospective and current patients. You are entitled to a Good Faith Estimate before services begin, and you may request an updated estimate at any time.

What Is a Good Faith Estimate?
A Good Faith Estimate is a written document describing the expected costs of the health care services you are scheduled to receive. The estimate is based on information known at the time it is created and does not include unknown or unexpected costs that may arise during treatment.

About Our Fees
Our practice includes multiple therapists, and session fees vary by provider. When you contact us, your therapist will discuss their specific fee with you directly. Sessions generally range from 45 to 60 minutes depending on the therapist and treatment approach.

Because the total length of treatment can be difficult to predict at the outset, your Good Faith Estimate will typically reflect a range of expected sessions and costs. The factors that may influence how many sessions are needed include the nature and complexity of your concerns, your goals for therapy, your progress over time, and your preferences about the pace and duration of treatment.

For example, a Good Faith Estimate provided to you might look like:

Depending on your needs and goals, you may require between [X] and [Y] sessions this year. At your therapist's rate of $[fee] per session, the estimated total cost would be between $[low] and $[high]. This estimate is valid for 12 months from the date it was provided.

Your therapist will provide you with a personalized Good Faith Estimate before or at the time your first appointment is scheduled, or within 3 business days of your request.

Your Rights If a Bill Exceeds Your Estimate
If you receive a bill that is $400 or more above the expected charges listed in your Good Faith Estimate, federal law allows you to dispute the bill. You can:

  • Ask your provider to update the bill to match the Good Faith Estimate

  • Ask to negotiate the bill

  • Ask about financial assistance options

  • Start a dispute resolution process with the U.S. Department of Health and Human Services (HHS)

If you use the HHS dispute resolution process, you must initiate it within 120 calendar days of receiving your bill. There is a $25 fee to start the process.

How to Request a Good Faith Estimate
To request a Good Faith Estimate, or if you have questions about fees before scheduling, please contact the therapist you are considering working with directly.

More Information
For more information about your rights under federal law:
Visit www.cms.gov/nosurprises
Call 1-800-985-3059.

This notice is provided in accordance with 45 CFR § 149.610 and the No Surprises Act, Pub. L. 116-260.