Good Faith Estimate

Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to provide a good faith estimate of expected charges for items and services to individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing, upon request or at the time of scheduling health care items and services.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

  • Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.

  • You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

  • 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 or picture of your Good Faith Estimate.

**GOOD FAITH ESTIMATE:** Below is an estimate of how much a year of therapy would cost if you were to meet with your therapist for 52 sessions per year, without skipping any weeks, or needing additional sessions. There are times where these fees change, and the fee you pay for services may be less or more than what is reflected below depending on your life circumstances. Additionally, not all clients will meet with their therapists on a weekly basis, or there may be times when a client needs additional sessions due to extreme stress or mental health crisis. The current full rates for counseling and psychotherapy services with Hallie Huffman, LCSW, LCAS are: 90-minute Intake Session at a rate of $175, and 50-minute Counseling/Psychotherapy Session at a rate of $140/session. $175 intake + ($140 session x 51) sessions per year = $7,315.00 per year. This is the rate of services for a private pay out of pocket fee. Rates are subject to change based on insurance coverage changes or when outside services are involved. Additional fees may be incurred if additional services are needed at a rate of $75 per 20-40 minutes per week. This can include fees for additional time for crisis management, case consultation with other providers, or psychoeducation for outside supports, etc.. For example, if after a 50 minute session there are three 12 minute calls, client will be charged the initial $140 for the original session, and then an additional $75 for the 36 minutes of additional time spent with client over the course of one week. By engaging in therapeutic services, you understand the rates estimated for your projected therapy treatment. For additional information on payments, fee schedules, and methods of payment, please refer to the “Practice Policies” document sent to you upon intake.

**Disclaimer:** This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. The Good Faith Estimate is not a contract and therefore does not require you to obtain the items or services provided by Hallie Huffman, LCSW, LCAS. This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with your therapist.  You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time. At the foundation of a good therapeutic relationship between client and therapist is the client’s right to autonomy and self-determination. Therefore, you (as the client) have the right to terminate services at any time. You additionally have a right to initiate a dispute resolution process if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate ($400 or more beyond the estimated charges). You may contact the health care provider to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the US Department of Health and Human Services. If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider, you will have to pay the higher amount.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov,

or call 1-800-985-3059.