Good Faith Estimate.

Your right to a Good Faith Estimate

Under the federal No Surprises Act, you have the right to receive a "Good Faith Estimate" explaining how much your medical and mental health care will cost.

Health care providers are required to give patients who don't have insurance, or who are not using insurance, an estimate of the expected charges for medical services, including psychotherapy.

What you're entitled to

• A written Good Faith Estimate before you schedule a service, or upon request.
• An estimate that includes expected charges for the items and services that are reasonably expected for your care.
• The right to dispute a bill if it is at least $400 more than your Good Faith Estimate.
• A copy of your Good Faith Estimate to keep for your records.

Our standard self-pay rate

At 3 Bridges Counseling Service, LLC, the standard self-pay rate for individual therapy is $200 per 60-minute session. A no-show or late cancellation fee of $75 may apply.

Your personalized Good Faith Estimate will be based on the services Donna recommends after an initial conversation about your needs and goals.

How to request your estimate

Make sure to save a copy or picture of your Good Faith Estimate. For questions or to request your estimate before scheduling, contact us:

Disputes

For questions or more information about your right to a Good Faith Estimate, or to dispute a bill, visit cms.gov/nosurprises or call 1-800-985-3059.