Good Faith Estimate

As a part of the federal No Surprises Act implemented in 2022, you are entitled to receive this “Good Faith Estimate” of what the charges could be for therapy services provided to you. While it is not possible for a therapist to know, in advance, how many sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of sessions you attend, your individual circumstances, and the type and amount of services that are provided to you. 

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The fee for a 50-minute individual therapy session (in person or via telehealth) is $135. Most clients will attend one therapy session per week, but the frequency of sessions that are appropriate in your case may be more or less than once per week, depending upon your needs. Based on a fee of $135 per session, the table shows the estimated charges. 

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The fee for a 50-minute therapy session for couples (in person or via telehealth) is $150. Most clients will attend one therapy session per week, but the frequency of sessions that are appropriate in your case may be more or less than once per week, depending upon your needs. Based on a fee of $150 per couple per session, the following are expected charges: ​

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Disclaimer

There may be times you need additional services based on your specific circumstance. 

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur.

 

You have a right to initiate a dispute resolution process if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges). The initiation of the dispute process will not adversely affect the quality of services provided to you by this provider. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059

You are encouraged to speak with your provider at any time about any questions you may have regarding your treatment plan, or the information provided to you in this Good Faith Estimate.

 

This Good Faith Estimate is not a contract. It does not obligate you to accept the services listed above.