Good Faith Estimate


In compliance with the “No Surprises Act” effective January 1, 2022, all healthcare providers are required to notify clients of their federal rights and protections against “surprise billing.” 

The law requires that we notify you of your federally protected rights to receive a notification when services are rendered by an out-of-network provider, if a client is uninsured, or if a client elects not to use their insurance.


Additionally, we are required to provide you with a “Good Faith Estimate” of the cost of services. The estimate provided is based on weekly sessions over the course of 12 months with 2 weeks off for holidays and vacations. Utilizing this information for the “Good Faith Estimate” equates to Intake and 49 individual weekly sessions. You are not required to attend this many sessions, it is only provided per federal law so that you are aware of the potential charges for
attending weekly sessions for a 12-month period. 

It is difficult to determine the true length of treatment for mental health care, and each client has a right to decide how long they would like to participate in mental health care. Therefore, we are also providing you with the fee schedule for the services typically offered by your therapist. We will collaborate with you on a regular basis to determine how many sessions you may need.

Estimate of what you may owe for 12 months of service based on 1 session per week: $6750

The estimated costs are valid for 12 months from the date of the Good Faith Estimate. If you have health insurance, and the services you are seeking are covered by your health care plan, you may be able to get the items or services described in this notice from providers who are in-network with your health plan.


Disclaimer: 
This Good Faith Estimate shows the costs of items and services that are reasonably expected for the above noted service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if you attend additional sessions or special circumstances occur. If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.


For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.