Good Faith Estimate

Your right to receive an estimate of expected charges

Under the federal No Surprises Act, people who do not have health insurance or who choose not to use their insurance generally have the right to receive a written Good Faith Estimate of the expected cost of non-emergency health care services.

You have the right to receive a Good Faith Estimate when you schedule services at least three business days in advance, and you may request one before scheduling. The estimate is not a bill. Centers for Medicare & Medicaid Services

Current service rates

Individual therapy sessions are 50 minutes and cost $175 per session.

Group sessions are 75 minutes and are offered on a sliding scale of $50–$75 per session.

A personalized Good Faith Estimate will reflect the services reasonably expected based on the information available when it is prepared, including the anticipated type, frequency, and duration of sessions. Because therapy is individualized, the length of treatment and number of sessions cannot always be predicted in advance. Your needs and preferences may change, and you may choose to pause or end services at any time.

The estimate does not include services that are not reasonably known or anticipated when the estimate is created. If the expected scope or cost of services changes, an updated estimate may be provided.

If your bill is substantially higher than your estimate

If a bill from a provider is at least $400 more than that provider’s Good Faith Estimate, you may be eligible to use the federal patient-provider dispute resolution process. The dispute generally must be started within 120 calendar days of the date on the original bill. Centers for Medicare & Medicaid Services

You may first contact the provider to ask about the difference, request that the bill be corrected, or discuss available options. You may also begin a dispute through the U.S. Department of Health and Human Services.

For more information, visit the CMS Medical Bill Rights website or call the No Surprises Help Desk at 1-800-985-3059. Keep a copy of your Good Faith Estimate and any bills you receive.

Questions or requests

To request a written Good Faith Estimate or ask a question about fees, contact:

Tishna Rollo, LPC
hello@tishnarollo.com
(512) 710-9781