Good Faith Estimate
Your Right to a Good Faith Estimate Under the No Surprises Act
Overview
Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage, or who are not seeking to file a claim with their plan or coverage (both privately and federally funded), of their ability to receive a Good Faith Estimate of expected charges.
Your rights
You have the right to receive a Good Faith Estimate explaining how much your mental health care will cost. Under the law, health care providers must give patients who don't have insurance, or who are not using insurance, an estimate of the expected charges for medical services, including psychotherapy and counseling services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy of your Good Faith Estimate.
Standard self-pay rates
The following are the standard self-pay rates for services at Greenleaf Counseling & Consulting, LLC. Your individualized Good Faith Estimate may vary based on your specific treatment needs, frequency of sessions, and anticipated duration of care.
| Service | CPT Code | Rate |
|---|---|---|
| Individual Therapy (16–37 min) | 90832 | $180 |
| Individual Therapy (38–52 min) | 90834 | $180 |
| Individual Therapy (53+ min) | 90837 | $180 |
| Couples / Family Therapy (with patient present) | 90847 | $210 |
What a Good Faith Estimate includes
When you receive a Good Faith Estimate, it will include the expected cost of items and services that are reasonably expected for your mental health care, including the cost of related services such as psychotherapy sessions. The estimate is based on information known at the time it is provided and does not include any unknown or unexpected costs that may arise during treatment.
How to request a Good Faith Estimate
You may request a Good Faith Estimate at any time — before or during treatment — by contacting us at jonathan@greenleafcc.org.
Disputing a bill
If you are billed for more than your Good Faith Estimate, you have the right to dispute the bill if the actual charges exceed the estimated charges by $400 or more. You may contact the U.S. Department of Health and Human Services (HHS) at (800) 985-3059 to learn more and to initiate the dispute process.
For questions or more information about your right to a Good Faith Estimate, or the dispute process, visit cms.gov/nosurprises.