New federal regulations implementing the No Surprises Act (enacted by Congress in 2020) went into effect on January 1, 2022. The aim of the law is to protect out-of-pocket, out-of-network consumers from unanticipated medical bills.

As part of the No Surprises Act, if you are paying out-of-pocket and/or are not using insurance, you are entitled to receive a Good Faith Estimate of what the charges could be for psychotherapy services provided to you. While it is not possible for a clinical social worker to know, in advance, how many sessions may be necessary or appropriate for a given person, The Good Faith Estimate Form will provide an estimate of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual circumstances, and the type and amount of services that are provided to you.

For questions or more information about your right to a Good Faith Estimate or the dispute resolution process, visit https://www.cms.gov/nosurprises/consumers or call 1- 800-985-3059. The initiation of the patient-provider dispute resolution process will not adversely affect the quality of the services furnished to you.

DISCLAIMERS:

• The information provided in the Good Faith Estimate is only that: an estimate. Actual healthcare items, services, or charges may differ or change throughout the year, even for long-term established clients. For new clients, I may revise your estimate once we have met and discussed more details around your symptoms, likely diagnoses, severity, and treatment plan, which may not be reflected in the Good Faith Estimate you initially receive. However, I will never schedule healthcare services or items without client consent, and clients may request an updated Good Faith Estimate at any time.

• The Good Faith Estimate is not a contract, and does not bind, obligate, or require any client to obtain healthcare services or items from me at any time. 

• There are no federal provisions allowing clients to waive their right to a Good Faith Estimate at this time. The regulation allows clients to waive some of the protections related to balance billing, but does not allow me as a therapist to bypass the Good Faith Estimate through a client waiver. As such, I am required by law to send all ongoing clients new Good Faith Estimates every 12 months; clients cannot opt-out, and are required to acknowledge receipt and understanding of each new Good Faith Estimate in order to comply with federal law so that we may continue working together.