Client Rights - Good Faith Estimate

Explanation of Good Faith Estimates

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In an attempt to make medical bills more transparent, healthcare providers are now required by federal law to provide self-pay clients with Good Faith Estimates for services that will be provided. We want you to understand the cost of therapy. At Healing with Grace Counseling Center we charge each client a per-session fee after each session. Your session fee will be set by our scheduler and or your therapist during your intake process. Our standard rates range from $60 up to $250 per session depending on the therapist and type of therapy involved. We will always be clear and upfront with you about your session fees and how you will be charged, but if you are ever uncertain about fees, charges, or our billing process, please let us know and we will be happy to answer any questions you might have. If you are unsure about the cost of therapy talk with us. When it comes to therapy the difficult part of providing a Good Faith Estimate is knowing how long your treatment might last. Each client has a unique background, distinct goals, and varying availability. We often find that significant progress can be made within six to eight therapy sessions.

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Additional Costs:

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Clients sometimes request additional services and there are charges for these services, such as document copies, cancellation fees, etc. the charges for these are outlined in your intake
paperwork and are not included in a Good Faith Estimate as they are non-standard and
unpredictable from the therapist/scheduler perspective.

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Requesting a Good Faith Estimate:

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Healing with Grace Counseling Center will be happy to provide you with a written Good Faith
Estimate at any time. All you have to do is ask your therapist. Your Good Faith Estimate will
show the costs of items and services that are reasonably expected for your health care needs.
The estimate is based on information known at the time the estimate was created. Your Good
Faith Estimate doesn't include any unknown or unexpected costs such as those mentioned
above, that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute the bill.

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Your right to dispute the bill:

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You may contact the health care provider to let them know the billed charges are higher than
your Good Faith Estimate. You can ask them to update the bill to match the Good Faith
Estimate, or ask to negotiate the bill. You may also start a dispute resolution process with the
U.S. Department of Health and Human Services (HHS). 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 your Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider, you will have to pay the higher amount.

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To learn more and get a form to start the process, or for more information about your rights to a Good Faith Estimates or the dispute process go to: www.cms.gov/nosurprises or call HHS at: (800) 368-1019. Keep a copy of your Good Faith Estimate in a safe place or
take pictures of it. You may need it if you are billed the higher amount.

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