Good Faith Estimate
Your Right to Know the Cost of Mental Health Services
As Required by the No Surprises Act
You Have the Right to Receive a “Good Faith Estimate”
Under federal law, health care providers must give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services before those services are provided.
This applies to mental health and therapy services, including individual therapy, couples therapy, family therapy, and psychological assessments.
What Is a Good Faith Estimate?
A Good Faith Estimate is a written document that shows the expected costs of mental health services. It is designed to help you understand and prepare for the cost of your care.
The estimate includes:
- The expected charges for therapy sessions or services
- Any additional related costs such as assessments or testing
- The total expected cost for the services you’ll receive
Important: This is an estimate based on the information available at the time. Your actual charges may differ if your diagnosis changes, if additional services are needed, or if complications or special circumstances arise.
Your Rights Under the No Surprises Act
Right to Receive an Estimate
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency therapy services. This includes individual sessions, couples therapy, family therapy, group therapy, and psychological assessments.
Written Estimate in Advance
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your scheduled service or item. You can also ask for a Good Faith Estimate before you schedule an appointment.
Right to Dispute Bills
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You have 120 calendar days from the date on the bill to start the dispute process.
Keep Your Documentation
Make sure to save a copy or picture of your Good Faith Estimate. You will need this documentation if you need to dispute a bill or have questions about your charges.
Who Is Eligible for a Good Faith Estimate?
You are entitled to receive a Good Faith Estimate if you are:
- Uninsured: You do not have health insurance coverage
- Self-Pay: You have insurance but choose not to use it for mental health services
- Out-of-Network: You are receiving services from a provider who is not in your insurance network and you are paying out-of-pocket
Note: If you are using your health insurance for services, your insurance company’s explanation of benefits will show what you owe. The Good Faith Estimate requirement applies specifically to uninsured and self-pay patients.
How to Request a Good Faith Estimate
You can request a Good Faith Estimate at any time:
- When Scheduling Services: Ask for an estimate when you schedule your first appointment or any new service
- Before Your Appointment: Contact our office at least 1 business day before your scheduled service
- For Future Services: Request an estimate for ongoing therapy to understand the expected costs
We will provide your Good Faith Estimate:
- In Writing: You will receive a written document (paper or electronic)
- Within Required Timeframes: At least 1 business day before your scheduled service, or within 3 business days if you request an estimate more than 3 days in advance of scheduling
- In Clear Language: The estimate will be easy to understand and will clearly show expected costs
What’s Included in Our Good Faith Estimate for Therapy Services
When we provide a Good Faith Estimate for mental health services, it will include:
| Service | What’s Included |
|---|---|
| Individual Therapy Sessions | Expected number of sessions, session length (typically 50-60 minutes), cost per session, total estimated cost for planned treatment period |
| Couples/Family Therapy | Expected number of sessions, session length (typically 50-90 minutes), cost per session, total estimated cost |
| Initial Consultation | Cost of first appointment including intake assessment and treatment planning |
| Psychological Testing/Assessments | Cost of testing materials, administration time, scoring and interpretation, written report |
| Additional Services | Any other expected costs such as communication with other providers, case management, or specialized interventions |
Understanding Your Estimate for Mental Health Services
Therapy Often Requires Ongoing Treatment
Unlike many medical services, mental health treatment often involves multiple sessions over weeks or months. Your Good Faith Estimate will reflect:
- The initial treatment phase we anticipate (e.g., 8-12 sessions)
- The expected frequency of sessions (e.g., weekly, bi-weekly)
- The total cost for that initial treatment period
Estimates May Change Based on Your Progress
Mental health treatment is personalized to your needs. Your actual treatment may differ from the initial estimate if:
- Your treatment goals change
- You need more or fewer sessions than initially anticipated
- Your diagnosis is refined after initial sessions
- New issues emerge that require attention
- You achieve your goals faster than expected
If your treatment needs change significantly from the original estimate, we will provide you with an updated Good Faith Estimate.
Session Frequency and Duration
Standard therapy sessions are typically:
- Individual Therapy: 50-60 minutes, weekly or bi-weekly
- Couples/Family Therapy: 50-90 minutes, weekly or bi-weekly
- Group Therapy: 90 minutes, weekly
Your estimate will reflect the recommended frequency and duration for your specific treatment plan.
If Your Bill Is Higher Than Your Estimate
You are protected from unexpected charges through the dispute resolution process:
When You Can Dispute a Bill
You have the right to dispute your bill if:
- The final bill is at least $400 more than the Good Faith Estimate you received
- You received a Good Faith Estimate before receiving the services
- The higher charges are not due to changes you requested or new diagnoses
How to Start a Dispute
- 1You must start the dispute process within 120 calendar days from the date you receive the bill
- 2Contact the federal patient-provider dispute resolution service or visit www.cms.gov/nosurprises
- 3Provide your Good Faith Estimate and the bill showing the higher charges
- 4An independent dispute resolution entity will review your case
Before Filing a Dispute: We encourage you to contact us first if you have questions about your bill. Many billing questions can be resolved through direct communication with our office. We are committed to transparency and fair billing practices.
Our Standard Rates for Self-Pay Clients
For your reference, our standard self-pay rates are:
| Service Type | Duration | Standard Rate |
|---|---|---|
| Initial Consultation (Free) | 15-20 minutes | No charge |
| Individual Therapy Session | 50-60 minutes | $150-$200 per session |
| Couples Therapy Session | 50-90 minutes | $175-$225 per session |
| Family Therapy Session | 50-90 minutes | $175-$225 per session |
| EMDR Intensive (Half-Day) | 2-3 hours | $450-$900 |
| EMDR Intensive (Full-Day) | 4-6 hours | $900-$1,500 |
Note: Rates may vary by therapist based on experience and specialization. Your personalized Good Faith Estimate will reflect the specific rate for your therapist and services.
Questions or Concerns?
We are committed to transparency in our billing practices and want you to fully understand the cost of your care.
For Questions About Your Good Faith Estimate:
- Contact our office at the information below
- Speak with your therapist or our billing department
- Request clarification or an updated estimate at any time
For Questions About the No Surprises Act:
Visit www.cms.gov/nosurprises or call 1-800-985-3059 for more information about your rights under federal law.
To Start a Billing Dispute:
Visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059 to initiate the patient-provider dispute resolution process.
Our Commitment to You
At Relationship Counseling Center of California, we believe in transparent, ethical billing practices. We are committed to:
- Clear Communication: Providing clear information about costs before you begin treatment
- Accurate Estimates: Giving you the most accurate estimate possible based on your anticipated treatment needs
- No Surprise Bills: Informing you of any significant changes to your treatment plan that might affect costs
- Accessible Support: Being available to answer questions about your estimate or bill at any time
- Fair Practices: Working with you to resolve any billing concerns or discrepancies
Your mental health is important, and we don’t want cost concerns to prevent you from getting the care you need. If you have questions about costs or payment options, please don’t hesitate to contact us.
Contact Us About Good Faith Estimates
To request a Good Faith Estimate or if you have questions about the cost of services:
Relationship Counseling Center of California
315 West Bedford Ave, 105D
Fresno, CA 93711
Phone: 559-633-9030
We will provide your Good Faith Estimate within the required timeframes and are happy to answer any questions about your expected costs.
Your mental health matters. Let’s make sure cost isn’t a barrier to getting the support you need.
Legal Notice: This page provides information about your rights under the No Surprises Act (Public Health Service Act Section 2799B-6). The information provided is intended to be a general summary and does not constitute legal advice. For complete information about the No Surprises Act and your rights, visit www.cms.gov/nosurprises or consult with a legal professional.