Tonya Mills Counseling & Psychotherapy

Your Right to a Good Faith Estimate

No Surprises Act.

A plain-language notice about what to expect from the cost of your care.

Under the federal No Surprises Act, you have the right to receive a Good Faith Estimate of expected charges for medical and mental health services if you are uninsured or if you have insurance but plan to self-pay (i.e. you choose not to file a claim with your insurance company).

What this means for you

Health care providers are required to give you a written estimate of expected charges for any non-emergency services when you schedule care, or when you request one.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
  • Make sure your provider gives you a Good Faith Estimate in writing at least 1 business day before your service. You can also ask for one before you schedule.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Save a copy or picture of your Good Faith Estimate.

Session rate

The standard session rate for individual psychotherapy in this practice is $175 per 50-minute session. Your Good Faith Estimate will reflect the expected number of sessions discussed at intake, based on your stated goals; it is an estimate, not a cap, and your actual course of treatment may be shorter or longer.

How to request a Good Faith Estimate

You can request a written Good Faith Estimate at any point — before scheduling or during our work together. Reach out by phone or email and I will send one to you within the required timeframe:

If you are billed substantially more than your estimate

If your final bill is at least $400 higher than your Good Faith Estimate, you have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process. You must start the dispute process within 120 calendar days of the date on your original bill.

For questions and more information about your right to a Good Faith Estimate, or to start a dispute, visit cms.gov/nosurprises or call 1-800-985-3059.

This notice is provided in accordance with 45 CFR § 149.610 and is for informational purposes only; it is not a contract or a guarantee of specific charges.