Right to a Good Faith Estimate

As per the "No Surprises" Act, you are entitled to and will be provided a Good Faith Estimate at the time of establishing care - provided that you are paying out of pocket, and are not intending to submit to your insurance for reimbursement - as well as at any point at which your payment for services is adjusted.

Important notes specific to mental health therapy:

I cannot predict the number of sessions expected, as this will vary - and possibly change - depending on your goals for treatment, influencing Problem(s) that may change/appear/shift, your risk and support needs at any given time, and many other factors. My core therapeutic philosophy is that I cannot somehow inherently know better than you what your experiences and needs are.

Frequency of treatment may be suggested to change, either permanently or temporarily, by either the client or the therapist at any time. In this case, completion of another Good Faith Estimate will be provided.

OMB Control Number 0938-XXXX

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill 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 medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• 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 www.cms.gov/nosurprises or call 800.976.7544.