Good Faith Estimate

What Is a Good Faith Estimate?

A Good Faith Estimate is a written explanation of the anticipated charges for your counseling services. It may include the cost of individual, couples, or family counseling and the estimated number or frequency of sessions, when known.

The estimate is not a bill or a contract requiring you to receive services. Actual costs may vary depending on your treatment needs, the number of sessions you attend, and any changes to your services.

When Will You Receive an Estimate?

If you are uninsured or paying for counseling without using health insurance:

• Appointments scheduled 3–9 business days in advance: You will receive a Good Faith Estimate within one business day after scheduling.
• Appointments scheduled 10 or more business days in advance: You will receive an estimate within three business days after scheduling.
• Estimates requested before scheduling: You will receive an estimate within three business days of your request.

You may request a Good Faith Estimate at any time, including before deciding whether to begin counseling.

What If Your Bill Is Higher Than Your Estimate?

If you receive a bill that is at least $400 more than your Good Faith Estimate from the same provider, you may be eligible to dispute the charges through the federal patient-provider dispute resolution process.

You generally have 120 calendar days from the date of your initial bill to begin the dispute process.

You may also contact The ALLICE Collective to discuss any differences between your estimate and your bill.

For more information about your rights, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059 .

Request a Good Faith Estimate

To request a written Good Faith Estimate for counseling services, please contact The ALLICE Collective.

A Good Faith Estimate is not a guarantee of treatment costs and does not prevent you from discussing your treatment options, session frequency, or anticipated expenses with your clinician.