Your right to a Good Faith Estimate

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

How this works at The Longwood Counseling Center

We are a private-pay practice, so every client receives a Good Faith Estimate. Ours is simple: $150 per individual session and $200 per couples session, with no additional charge for EMDR, plus any late-cancellation or missed-session fees described in your intake paperwork. Because therapy is ongoing, your estimate will state the expected frequency and number of sessions for up to twelve months, and we’ll give you an updated estimate if anything about your care or our fees changes.

We send the estimate through your secure client portal when you schedule your first appointment, so you can save and print it. Any time you ask us about cost, we treat it as a request for a Good Faith Estimate. If you would like one in an alternative format or language, let us know.

A Good Faith Estimate is not a contract, and it doesn’t require you to obtain the services listed. It is our best estimate, made in good faith, of what you can expect to pay.

Model notice language from the Centers for Medicare & Medicaid Services (45 CFR § 149.610). Related: fees and insurance · Notice of Privacy Practices.