Good Faith Estimate

Your right to a Good Faith Estimate under the No Surprises Act

You have the right to receive a Good Faith Estimate explaining how much your care will cost.

Under the law, health care providers must give patients who don’t have insurance, or who are not using insurance, an estimate of the expected charges for medical services, including psychotherapy.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including psychotherapy.
• You can ask for a Good Faith Estimate before you schedule a service, or at any time during treatment.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

How this applies here

This is a private-pay practice. The current fee is $325 for a 50-minute individual session, payable at the time of service. Because ongoing psychotherapy has no fixed end date, your Good Faith Estimate will reflect an expected course of care based on the fee above and the frequency we anticipate, and it can be updated as your needs change. You will receive a written Good Faith Estimate before services begin, and you may request an updated one at any time.

Questions and disputes

For questions or more information about your right to a Good Faith Estimate, or to learn how to dispute a bill, visit www.cms.gov/nosurprises or call the CMS No Surprises Help Desk at 1-800-985-3059. You may also contact the practice directly at 415-484-2050.