Good Faith Estimate

This law is intended to increase transparency and help you make informed decisions about your care.

You Have the Right to Receive a Good Faith Estimate

If you are uninsured or self-paying for services, you have the right to receive a Good Faith Estimate that outlines the expected cost of non-emergency items and services, including:

Individual therapy sessions

Couples or family sessions

Coaching Packages Groups (If offered)

Any other non-emergency mental health services

Your Good Faith Estimate will include:

The provider's name and contact information

A description of the service(s)
The estimated cost per session

The projected frequency and duration of services

The total expected cost over a 12-month period (or anticipated treatment period)

What You Can Expect

You have the right to receive a Good Faith Estimate in writing at least 1 business day before your scheduled service, or upon request.

The estimate is not a contract or a guarantee of exact fees, and it does not require you to continue receiving services.

The actual length and frequency of treatment may vary depending on your needs, progress, and treatment goals, which you will discuss with your clinician.

If your billed charges exceed the Good Faith Estimate by $400 or more, you have the right to initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS).

Example of Cost Estimate This is only an example and not a personalized GFE.

Initial intake session: $350

Ongoing 50-minute therapy sessions: $300/session

Estimated frequency: Weekly (4 sessions/month) Estimated 12-month cost: $300 x 4 x 12 = $14,400

Your personalized estimate may differ depending on your treatment needs and session types.

Dispute Resolution If you receive a bill that is at least $400 more than your Good Faith Estimate, you can file a dispute with the U.S. Department of Health and Human Services (HHS). You must initiate the dispute within 120 days of receiving the bill.

For more information or to start the dispute process, visit:

📎 https://www.cms.gov/nosurprises/consumers

📞 Or call: 1-800-985-3059

Questions?

To request a Good Faith Estimate or for questions about billing and fees, please contact:

Sound Mind Collective LLC 79 E Putnam Ave Greenwich, CT 06830

[email protected] ‭(914) 538-2438‬ call/text