GOOD FAITH ESTIMATE
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Effective 01/01/2022, under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- 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.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 877-267-2323.
The fees charged for my services are listed below.
Rates
$275 for 90 minute Initial Intake/Diagnostic Session
$200 for 52-60 Minute Session (Individual)
$275 for 52-60 Minute Session (Couples)
