Good Faith Estimate (No Surprises Act)

Description of Services

You are receiving individual psychotherapy services from a licensed mental health professional. These sessions are conducted virtually. Services may include discussion, counseling, and evidence-based therapeutic interventions aimed at improving emotional, behavioral, or relational concerns.

Expected Charges

  • Initial intake session: 75–90 minutes — $200

  • Regular psychotherapy sessions: 55 minutes — $150 per session

Therapy is open-ended, meaning the number of sessions depends on your goals, progress, and other individual factors. This estimate is intended to help you anticipate potential costs but is not a binding contract. Because ongoing therapy varies from person to person, the total number of sessions is uncertain.

Additional Fees

No additional fees are anticipated at this time. If any additional services are required, you will be informed before they are provided and given an updated estimate.

Your Rights Under the Good Faith Estimate Law

Under federal law (the No Surprises Act), you have the right to:

  • Receive a Good Faith Estimate (GFE) that explains the expected cost of your care.

  • Request a Good Faith Estimate at any time—before scheduling, before beginning services, or at any point during treatment.

  • Receive an updated estimate if your fees or treatment plan change.

  • Dispute a bill if the final charges are at least $400 more than your Good Faith Estimate.

  • Receive this estimate in writing, and keep a copy for your records.

This estimate is based on the information available at the time it is created and may change as your needs change. If you receive a bill more than $400 above this estimate, you can initiate a dispute process.

For more information about your right to a Good Faith Estimate, visit: www.cms.gov/nosurprises

This Good Faith Estimate remains in effect unless fees change or you request a revised estimate.