Good Faith Estimate

In compliance with the No Surprises Act that went into effect January 1, 2022, all healthcare providers are required to notify clients of their Federal rights and protections against potential “surprise billing.” 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 do not have insurance or who are not using insurance an estimate of the bill for medical items and services.

●      You are entitled to receive this “Good Faith Estimate” of your potential charges for psychotherapy services provided to you. While it is not possible for a psychotherapist to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, the Good Faith Estimate provides an estimation of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual circumstances, and the type and amount of services that are provided to you. The Good Faith Estimate is not a contract and does not obligate you to obtain any services from the provider listed on the Good Faith Estimate form.

●      During the initial 15 min consultation call the Good Faith Estimate will be verbally provided to you. In addition, the Good Faith Estimate will be available in writing through SimplePractice Portal.

●      If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You have a right to initiate a dispute resolution process with U.S Department of Health and Human Services (HHS) if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges). If you choose to utilize this dispute option, you will be required to submit your claim within 120 calendar days from the date of your first bill. There is a $25 fee to utilize HHS dispute process.

●      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 800-985-3059.