Good Faith Estimate

Under the federal law, "No Surprises Act", health care providers are requires to provide clients who do not have insurance, are not using insurance for therapeutic services, and are electing to self-pay with a good faith estimate (GFE). You are entitled to receive an estimate of charges for services at Mind Embody Psychotherapy. 

We at Mind Embody Psychotherapy value transparency, so here is what you need to know:

• You are entitled to receive a statement of your expected cost for mental health treatment.

• Upon your request, you may receive a good faith estimate within 3 days of your request and is provided before services are rendered.

• The estimate includes a list of services and their estimated costs (e.g., session cost, late cancellation/no-show fees).

• If you have a bill that is at least $400 more than your good faith estimate, you are entitled to dispute the charges.

Good Faith Estimate Example:
If you are paying out-of-pocket for therapy services at Mind Embody Psychotherapy, your estimated expense for a 50-minute session is $___ per session. If you are engaged in sessions once per week, that is approximately $___ per month. This cost may change if you are engaging in more or less sessions per week or per month.
 
For additional information, please visit: https://www.cms.gov/nosurprises