Good Faith Estimate

Understanding Your Therapy Costs

You have the right to receive a Good Faith Estimate of the expected cost of your mental health services if you are uninsured or choose not to use your health insurance (self-pay).

Before beginning services, you will receive information about my fees and an estimate of the expected costs of your care. A Good Faith Estimate is not a bill or a contract; it is an estimate based on the services that are reasonably expected at the time it is prepared.

Because therapy is an ongoing and individualized process, the actual number of sessions you may need can vary. The estimate may not include services or circumstances that could not reasonably be anticipated when the estimate was prepared.

If your final bill is $400 or more above the total expected charges listed in your Good Faith Estimate, federal law may give you the right to dispute the bill through the Patient-Provider Dispute Resolution process.

Please keep a copy of your Good Faith Estimate and compare it with your bills. If you have questions about your estimate, fees, or billing, please contact me directly.

For questions or more information about your right to a Good Faith Estimate, please visit www.cms.gov/nosurprises.