You have the right to receive a Good Faith Estimate of expected charges for your therapy services. The Good Faith Estimate is a written estimate of the cost of our services, provided to clients who do not have insurance or choose not to use their insurance for treatment. This is part of a federal law called the No Surprises Act, which helps ensure transparency in health care costs and protect clients from unexpected bills.

What is a Good Faith Estimate?

A Good Faith Estimate (GFE) is an estimate outlining the expected charges for the mental health services you seek. It lists the services we anticipate providing to you and the estimated fees for those services. The estimate is based on the information we have at the time of scheduling or upon your request. Importantly, this is not a bill – it’s a forecast of what your care may cost, so you can plan accordingly.

• Transparency for Your Treatment: The GFE will give you a clear idea of the types of therapy sessions or services we expect to provide, approximately how many sessions or the length of time we anticipate your treatment might last, and the cost per session as well as the total estimated cost for that period of care.
• For Self-Pay Clients: We provide GFEs to clients who are paying out-of-pocket for services (whether you have no health insurance, or you have insurance but prefer not to use it for therapy with us). If you will be using your health insurance benefits for therapy, then a Good Faith Estimate is not required – you would instead be responsible for any co-pays, deductibles, or coinsurance determined by your insurance.

Your Right to a Good Faith Estimate

Under the law, health care providers must give you a Good Faith Estimate if you are not using insurance. Here’s what that means for you:

• Receive an Estimate in Advance: If you schedule a therapy session at least 3 business days ahead of time, we will send you a Good Faith Estimate within 1 business day of your scheduling. For sessions scheduled further in advance (10+ business days), you will receive the estimate within 3 business days. You can also request a Good Faith Estimate at any time, even before booking a session – we will provide one within 3 business days of your request.
• Easy to Understand Format: Your estimate will be provided in writing (either as a paper document or via email, according to your preference). If we email it, it will be in a format that you can save and print for your records. We write estimates in clear, plain language to make them easy to understand.
• No Surprises in Billing: The estimate will include all reasonably expected charges for your mental health services at our practice. This includes the session fees and any standard related costs we can anticipate. The goal is to prevent surprise bills – you should know in advance roughly what your care will cost.
• Right to Ask Questions or Updates: If anything in your Good Faith Estimate is unclear, or if your treatment plan changes, you are welcome to ask questions. And if your planned services change, we will update your estimate and give you a revised copy reflecting any significant changes in expected cost or services.

What is Included in Your Good Faith Estimate

Your Good Faith Estimate will include the following details:

• Your Name and Information: It will identify you (the client) by name and date of birth.
• Description of Services: A list of the therapy services you are scheduling or requesting. For example, it might state “50-minute individual psychotherapy sessions, once per week.” If we anticipate a certain number of sessions or a set time period for your care (for instance, an estimate might cover 3 months of weekly therapy), that will be noted as your anticipated course of treatment.
• Estimated Costs: The expected fee for each session or service and the total cost for the set of services described. For instance, if our standard session rate is $X and we plan 10 weekly sessions, the estimate will show the math: $X per session × 10 sessions = $X0 total. This allows you to see how the costs add up over the duration of the estimate period.
• Provider and Practice Info: The name of your therapist and our practice, including contact details and any relevant identifiers (such as the therapist’s license number or National Provider Identifier). We want you to know exactly who will be providing the service and billing for it.
• Additional Services (if any): We will list any additional items or services we expect might be needed as part of your treatment plan. In most cases of psychotherapy, the primary service is your therapy session. We do not anticipate other fees.

Please note: The Good Faith Estimate covers only the services listed. It does not include any unplanned or unknown services that might arise. For example, if during the course of therapy you and your therapist decide to add a different service or extend treatment longer than initially estimated, that would be handled with a new or updated estimate at that time.

How to Obtain a Good Faith Estimate

1. Scheduling: When you call or email to schedule your first appointment, we will ask if you have insurance you plan to use. If you are uninsured or opting to self-pay, we will note that you are eligible for a Good Faith Estimate.
2. Receiving the Estimate: We will prepare your personalized Good Faith Estimate and send it to you in writing. Typically, we will email it to you at the email address you provide. If you prefer a mailed paper copy or to receive it in person, let us know – we can accommodate your preferred delivery method. We strive to send out the GFE promptly (usually within 1 business day after scheduling your session). In all cases, you will receive the estimate no later than at least 1 business day before your scheduled appointment.
3. Review and Questions: Once you receive the estimate, please review it. You do not need to sign it or take any action – it is for your information and peace of mind. If you have any questions about the charges or if something doesn’t look right, you can contact us to clarify. We’re happy to explain how we arrived at the estimate or answer any concerns.
4. Updates: If you continue therapy over time, remember that the Good Faith Estimate may cover a set period (for example, up to 12 months of treatment). We will update your estimate at least annually or whenever there is a significant change to your treatment plan (such as adding a new service or changing the frequency of sessions). You can also request an updated estimate at any time. We will keep a copy of each estimate in your client record, so if you ever misplace it or need another copy, just ask.

Questions or More Information

We are committed to transparency and want you to feel comfortable with the financial aspect of your care. If you have any questions about your Good Faith Estimate or our fees, please contact our office at:

• 📞 Phone: (618) 582-3021
• 📧 Email: [email protected]

Our team will gladly assist you and answer any questions. We can also provide additional copies of your estimate or further breakdowns if needed. For general information about the No Surprises Act and Good Faith Estimates, you can also visit the official CMS website at www.cms.gov/nosurprises (which has resources for consumers).

Important Disclaimers about Your Good Faith Estimate

• This is an Estimate, Not a Contract: The Good Faith Estimate is for your information only. It is not a contract and not a guarantee of final costs. You are not required to accept the services listed just because you received an estimate. You are free to choose your provider and services.
• Actual Costs May Vary: While we do our best to estimate accurately, the actual amount you are charged may vary from the estimate. Changes can occur because your needs might change or if you decide to extend therapy longer than initially planned. We will discuss any notable changes in your treatment or costs with you. No additional services will be provided (and no additional charges will incur) without your consent.
• No Unknown Fees: The estimate does not include any unexpected or unforeseen costs that might come up during treatment. In a therapy context, surprises are uncommon, but if an unanticipated situation arises that affects your treatment plan or costs, we will notify you and provide a revised Good Faith Estimate.
• Right to Dispute: If you receive a bill that is at least $400 more than the amount shown in your Good Faith Estimate and you did not agree to added services, you have the right to dispute the charges. You can contact us first to let us know of the discrepancy – we will work with you to review the bill. If needed, you can initiate a formal dispute resolution process through the U.S. Department of Health and Human Services. Starting a dispute will not affect your ability to continue to receive services. We will provide information on how to take this step if it ever becomes necessary.
• Keep a Copy: We encourage you to save a copy of your Good Faith Estimate (print it out or save the email). Having it on hand is useful for reference, especially if you need to compare it to any future bills.