Good Faith Estimate Notice

Under the No Surprises Act, you have the right to receive a Good Faith Estimate of the expected charges for psychotherapy services if you are uninsured or choose to self-pay.

A Good Faith Estimate outlines the anticipated cost of services based on the information available at the time it is provided. This estimate is not a contract and may be subject to change if your treatment needs or frequency of sessions change.

Who can request a Good Faith Estimate

You are entitled to receive a Good Faith Estimate if:

  • You do not have health insurance, or

  • You choose not to use your health insurance and pay out of pocket

How to request a Good Faith Estimate

You may request a Good Faith Estimate:

  • Before scheduling services, or

  • At any time during treatment

To request an estimate, please contact me directly. Estimates are provided in writing.

Questions or disputes

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

You may learn more about your rights under the No Surprises Act by visiting:
www.cms.gov/nosurprises