Good Faith Estimate
As a client, you are entitled to a Good Faith Estimate. While it is not possible for a psychotherapist to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, a Good Faith Estimate provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual circumstances, and the type and amount of services that are provided to you.
There may be additional items or services that I may recommend as part of your care that must be scheduled or requested separately and may not be reflected in your Good Faith Estimate. The estimate is not a contract and does not obligate you to obtain any services from your provider listed, nor does it include any services rendered to you that are not identified in the estimate.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit https://www.cms.gov/nosurprises/consumers or call 1- 800-985-3059. The initiation of the patient-provider dispute resolution process will not adversely affect the quality of the services furnished to you.
You have the right to initiate a dispute resolution process if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges)
After you receive a copy of the Good Faith Estimate, please keep it in a safe place or take a picture of it. If you have any questions, please feel free to contact me anytime.
