Good Faith Estimate for Uninsured and Self-Pay Clients

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Under the federal No Surprises Act, a health care provider has to give people who do not have insurance, or who choose not to use it, a written estimate of what their care will cost before it starts. This page is that notice for Healing Within Counseling, and it explains how to get your estimate.

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What you have a right to

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You have the right to receive a Good Faith Estimate of the expected charges for your care here. Section 2799B-6 of the Public Health Service Act requires it for any client who is uninsured or is not using insurance, and it covers psychotherapy. The estimate lists the services we reasonably expect to provide, the cost of each, and the total for the period it covers.

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What ours looks like

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Individual therapy at Healing Within Counseling is $150 for a 60 minute session when you pay out of pocket. Your estimate lists that rate, how many sessions we expect over the period we are estimating, and the total. Nobody can know at session one exactly how many sessions you will need, so the estimate covers a defined stretch of time, says plainly that it is an estimate, and gets updated in writing if the plan changes.

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When you get it

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You can ask for a Good Faith Estimate before you schedule anything, at any point while you are a client, or both. If you schedule at least three business days ahead, we give you the estimate within one business day of scheduling. If you ask for one without scheduling, we give it to you within three business days. It comes in writing, on paper or by email, whichever you prefer, and a copy stays in your record.

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If the bill comes in higher

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If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute it through the federal patient-provider dispute resolution process. You have 120 calendar days from the date on the bill to start. You can begin at www.cms.gov/nosurprises or by calling 1-800-985-3059. Keep a copy of your estimate. It is the document the whole process runs on.

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A Good Faith Estimate is not a contract. It does not require you to get the care it describes, and it does not limit your right to ask about cost at any time. This notice is provided under 45 CFR 149.610.