No Surprises Act Notice (Good Faith Estimate)

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

Under the No Surprises Act (Section 2799B-6 of the Public Health Service Act), health care providers are required to give uninsured or self-pay clients an estimate of expected charges for non-emergency services, including psychotherapy.

This notice applies to therapy clients only.

What is a Good Faith Estimate (GFE)?

A Good Faith Estimate outlines the anticipated cost of services you may receive, such as:

  • Weekly or twice-monthly therapy sessions

  • Individual, couple, or partner therapy

  • Extended sessions or intensives (if applicable)

The estimate will include:

  • The number of expected sessions (if known)

  • The cost per session

  • Any additional anticipated fees (e.g., documentation you request, extended sessions)

Therapy fees at The Holistic Counseling Collective, PLLC are set and transparent and upon request you can receive a copy of our fees in writing. GFEs are meant to help you budget—not to lock you into treatment or guarantee outcomes.

When Will I Receive My Good Faith Estimate?

You will receive your GFE in writing:

  • At least 1 business day before your first scheduled session, if your appointment is scheduled at least 3 business days in advance

  • Within 3 business days of scheduling, if your appointment is more than 10 days out

  • Upon request at any time, even if you have not yet scheduled

You may request a new GFE at any point during treatment.

What If Actual Costs Change?

Your GFE outlines anticipated costs.
Actual total costs may differ depending on:

  • The length of therapy

  • Changes in frequency

  • Clinical need

  • Your personal goals

If your actual charges exceed the GFE by $400 or more, you have the right to dispute the bill through the U.S. Department of Health & Human Services (HHS).

How to Dispute a Bill

If you believe you were billed more than $400 above your GFE, you may file a dispute.

To dispute a bill, you must:

  • Keep a copy of your Good Faith Estimate

  • File your dispute within 120 days of receiving the bill

  • Pay a small administrative fee (currently $25) for HHS to review the dispute

If the dispute is successful, fees may be adjusted.

Where Can I Learn More?

Visit: www.cms.gov/nosurprises
Call: 1-800-985-3059

Request Your Good Faith Estimate

You may request a personalized Good Faith Estimate at any time by contacting:

mk@theholisticcounselingcollective.com