Good Faith Estimate
Your Right to Receive an Estimate of Expected Costs
Under the No Surprises Act, clients who do not have health insurance or who choose not to use their insurance have the right to receive a Good Faith Estimate explaining the expected cost of their mental health services.
A Good Faith Estimate is not a bill or a contract. It is an estimate based on the information available when it is prepared. The total cost of therapy will depend on your individual needs, the type and frequency of services provided, and the length of time you participate in therapy.
When You Will Receive an Estimate
If you schedule an appointment at least three business days in advance, we will provide you with a written Good Faith Estimate within the required timeframe. You may also request an estimate before scheduling services.
Your estimate may include:
The expected type and frequency of therapy services
The fee for each service
The estimated length of treatment
The estimated total cost of services
Applicable diagnosis and service codes, when required
Because it can be difficult to determine the exact length of therapy in advance, your estimate may cover a specific period of time. We may provide an updated estimate if your treatment needs, session frequency, fees, or services change.
Fees and Payment Information
Our current fees and payment options are available on our Rates & Insurance page. Your individualized Good Faith Estimate will include the expected cost of the specific services discussed with your therapist.
You are only responsible for the services you choose to receive. You may discontinue therapy at any time, subject to any applicable cancellation or missed-appointment fees outlined in our practice policies.
If Your Bill Is Higher Than Your Estimate
If you receive a bill from a provider that is at least $400 more than the amount listed on your Good Faith Estimate, you may be eligible to dispute the bill through the federal patient-provider dispute resolution process.
The dispute generally must be started within 120 calendar days of receiving the initial bill. Please keep a copy of your Good Faith Estimate for your records.
For additional information about your rights, visit the Centers for Medicare & Medicaid Services or call the No Surprises Help Desk at 1-800-985-3059.
Request a Good Faith Estimate
To request a Good Faith Estimate or ask questions about expected costs, please contact Six Pines Counseling through our secure contact form or client portal.
This notice does not require you to receive services from Six Pines Counseling and does not prevent you from seeking services from another provider.