Good Faith Estimate

Your right to an estimate under the No Surprises Act

You have the right to receive a Good Faith Estimate explaining how much your care will cost.

Under the law, health care providers must give clients who don't have insurance, or who are not using insurance, an estimate of the expected charges for medical and mental health services. As a private-pay practice, Andara Psychotherapy provides this estimate to every client who is not billing insurance.

What you're entitled to

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including psychotherapy.
• You can ask your provider, or any provider you choose, for a Good Faith Estimate before you schedule a service.
• If you schedule a service at least 3 business days in advance, you'll receive a Good Faith Estimate in writing within 1 business day of scheduling. You can also request one at any time.
• Because the length of therapy varies from person to person, your estimate reflects an expected per-session fee and an anticipated range of sessions; it can be updated as the work continues.

Our fees

Individual sessions are $300 and couples sessions are $400, each 50 minutes. A written Good Faith Estimate based on your anticipated care will be provided before services begin, and is available on request at any time.

If your bill is higher than your estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. You may contact us to let us know the billed charges are higher than the estimate, and you can ask for an updated estimate, negotiate the bill, or ask about financial assistance. There is also a federal patient-provider dispute resolution process you may use within 120 days of the date on your bill.

Questions and more information

Keep a copy of your Good Faith Estimate in a safe place. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

To request a Good Faith Estimate, contact Joannyanglmft@andarapsychotherapy.com.

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