Policies

Good Faith Estimate

Last updated October 6, 2026

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

Your rights under the No Surprises Act

Under the law, health care providers need to give patients who don't have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate and the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1‑800‑985‑3059.

Who gets one

You'll receive a Good Faith Estimate if you don't have health insurance, or if you have insurance but choose to pay for therapy on your own instead of billing your plan. If you're using your Aetna or UnitedHealthcare benefits, your cost is set by your plan instead.

Current self-pay fees

Service	Billing code	Fee
Free consultation call (15 minutes)	None	$0
Intake and initial evaluation	90791	$200
Individual therapy session (55 minutes)	90837	$160

Your estimate is based on these fees, the number of sessions we expect, and how often we plan to meet. A diagnosis code from your intake is added once it's known.

Because therapy is ongoing, one estimate can cover up to 12 months of expected sessions. You'll get an updated estimate if your plan changes, such as meeting more often, or when 12 months have passed.

Good to know

• The estimate is not a contract. You don't have to receive the services listed on it.
• It covers only the services I provide. Care from other providers, such as a psychiatrist or an ADHD evaluation, is billed separately by them.
• The total may change if we add or change services. If that happens, I'll tell you and update the estimate.

If your bill is $400 or more over the estimate

You can start a dispute through the federal patient-provider dispute resolution process within 120 calendar days of the date on the original bill. There is a $25 fee to use the dispute process. Please reach out first, too. I'm glad to talk it through and fix any mistake.

Questions