Good Faith Estimate for Individual Counseling Services
What is a Good Faith Estimate?
Under the No Surprises Act (effective January 1, 2022), health care providers and facilities are required to give clients who are uninsured—or who are not using their insurance—an estimate of the expected charges for health care services. This is to help you understand potential costs and avoid unexpected bills.
Your Right to a Good Faith Estimate
- You have the right to receive a written Good Faith Estimate at least one business day before your scheduled health care services, or upon request, when scheduling.
- If you receive a bill 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.
Services We Provide
Our practice offers individual and group counseling services for a variety of issues and goals. Depending on your needs, we may recommend:
- Initial Intake/Assessment: A comprehensive assessment to determine your treatment goals.
- Ongoing Counseling Sessions: Regular sessions (typically once per week or every other week), focusing on your specific concerns and therapeutic goals.
- Additional or Specialized Services: If we determine that you may benefit from other forms of therapy, adjunct services, or community resources, we will discuss those options with you as well.
We will provide you with an individualized Good Faith Estimate once you have scheduled services with a specific therapist.
What to Expect in Your Personal GFE
- Service Descriptions: Details about recommended services (e.g., intake session, ongoing counseling).
- Frequency and Duration: Typical session length and estimated number of sessions.
- Estimated Costs: Your per-session rate and total estimated cost for the recommended duration of therapy, including any applicable sliding scale arrangements.
- Optional or Additional Services: Information on other therapeutic modalities or workshops that might complement your treatment.
Changes to Your Estimate
- The Good Faith Estimate is not a contract. It reflects our best assessment of your costs based on available information.
- Actual charges may vary if your treatment plan changes or if you request additional services.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the charges.
Dispute Resolution
If your billed charges exceed the Good Faith Estimate by $400 or more:
- Contact Us: We are committed to addressing any discrepancies and working with you to understand or correct the charges.
- File a Dispute: You have the right to file a dispute with the U.S. Department of Health & Human Services. Visit www.cms.gov/nosurprises or call 1-800-985-3059 for more information.
Contact Us
- Phone: 214-918-1758
- Email: info@layerscs.com
For more information about your rights and protections, including the right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
