What is a Good Faith Estimate?
Under Section 2799B-6 of the Public Health Service Act (the "No Surprises Act," effective January 1, 2022), healthcare providers must give patients who are uninsured or who choose to pay out-of-pocket a Good Faith Estimate of expected charges for services. This is a federal patient-rights law that applies to all healthcare providers, including mental health professionals in private practice.
You have the right to receive a Good Faith Estimate explaining how much your medical and mental health care will cost. It includes both single-visit charges and reasonable estimates of total expected costs over the course of services.
When you'll receive your estimate
You will receive a written Good Faith Estimate at intake, before services begin. The estimate will be specific to you and the services I recommend. If we agree to a particular treatment program (3, 6, or 9 months), the estimate will reflect the expected total cost over that program.
You can also request a Good Faith Estimate from any healthcare provider at any time before scheduling a service.
Standard fee ranges
The following are the standard fees for services at Vitara Therapy. Your personalized Good Faith Estimate will reflect the actual services planned for your care.
| Service | Duration | Fee |
|---|---|---|
| Initial intake session | 60 minutes | $275 |
| Ongoing individual session | 50 minutes | $220 |
| 90-day treatment review | 50 minutes | $220 |
Estimated total cost ranges by program length
The following estimates are for typical program engagements at standard fees. Your actual cost depends on cadence, length, and any modifications during treatment.
| Program | Typical session count | Estimated total |
|---|---|---|
| 3-month program | ~12 sessions + intake | ~$2,915 |
| 6-month program | ~24 sessions + intake | ~$5,555 |
| 9-month program | ~30–36 sessions + intake | ~$6,875 – $8,195 |
What your personalized estimate will include
The Good Faith Estimate you receive at intake will include:
- Your name and date of birth
- A description of the primary service being provided
- An itemized list of expected services, with diagnosis and service codes where applicable
- The expected charge for each service
- The total expected charge for the period covered by the estimate
- The provider's contact information (mine)
- The date of the estimate
- A disclaimer that the estimate is not a contract and does not obligate you to receive the services listed
Your right to dispute charges
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process.
To initiate a dispute, you must file your dispute within 120 calendar days of receiving the bill. There is a $25 fee to file a dispute, which is refunded if the dispute is decided in your favor.
To learn more or to start a dispute, visit www.cms.gov/nosurprises or call 1-800-985-3059.
If you have insurance
The No Surprises Act's Good Faith Estimate requirement applies primarily to patients who are uninsured or who choose to pay out-of-pocket rather than use insurance. If you are using in-network insurance, your insurance plan provides similar cost disclosures through their own processes (Summary of Benefits, Explanation of Benefits, etc.).
If you are using out-of-network insurance and submitting superbills for reimbursement, you may still want a Good Faith Estimate of your out-of-pocket costs before the reimbursement is processed. I'm happy to provide one on request.
Questions
If you have questions about your Good Faith Estimate, your rights under the No Surprises Act, or the dispute process, contact me directly or visit www.cms.gov/nosurprises.
Valeria Londono, LMHC
Vitara Therapy PLLC
Email: contact us