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Good Faith Estimate

Your Right to a Good Faith Estimate under the No Surprises Act

Who this applies to

This federal protection applies to clients who are uninsured or who have insurance but choose not to use it (self-pay) for our services. If you're using in-network insurance benefits, your costs are determined by your plan instead.

You have the right to a Good Faith Estimate

Under Section 2799B-6 of the Public Health Service Act (the "No Surprises Act"), health care providers must give patients who don't have insurance — or who aren't using insurance — an estimate of the expected charges for medical and mental health services, including psychotherapy.

What's included in your estimate

  • The expected charges per session, including the service code (CPT).
  • The diagnostic code(s) we anticipate using, when available.
  • The expected number of sessions over a defined period, based on your needs.
  • A reminder that your estimate is based on the information known at the time and may change.

Because therapy is collaborative and ongoing, your actual course of care may be shorter or longer than estimated. We'll talk openly with you about that as we go.

When you'll receive your estimate

  • You'll receive your estimate before your first session — within the timeframes required by federal rules.
  • You can also request one at any time, in writing or by phone, before scheduling.
  • If your care plan changes substantially, we'll provide an updated estimate.

Your right to dispute a bill

If you receive a bill that is at least $400 more than your Good Faith Estimate for that provider, you may be eligible to dispute the bill through the federal patient-provider dispute resolution process. You generally have 120 calendar days from the date of the bill to start the dispute process.

For more information or to begin a dispute, visit www.cms.gov/nosurprises or call 1-800-985-3059.

How to request your estimate

You can request a Good Faith Estimate before you schedule, or any time during your care:

Keep a copy of your Good Faith Estimate in a safe place — you may need it if you choose to dispute a bill.

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