Your Right to Receive a Good Faith Estimate of Expected Charges

Under the law, health care providers are required to give patients who do not have insurance, or who are not using insurance, an estimate of the expected charges for medical services, including psychotherapy services.

You have the right to receive a Good Faith Estimate explaining how much your medical care may cost.

What This Means for You

If you are uninsured or not using your insurance benefits, you are entitled to receive a written estimate of the expected cost of services before receiving care.

The Good Faith Estimate will include:
The expected cost of scheduled services
The expected cost of any additional related services that may reasonably occur during treatment
You may request a Good Faith Estimate before scheduling services or at any time during treatment.
Cost of Services

For Libby Coufal, LCSW:

Standard Individual Therapy Session (50 minutes):
$200 per session

The Good Faith Estimate will provide an estimate of the total cost of therapy services based on the information available at the time it is created. Because psychotherapy is individualized and the length of treatment varies, the total cost may differ depending on your needs and treatment plan.

If You Receive a Bill Higher Than Your Good Faith Estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

You may initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS).

You must start the dispute process within 120 days (4 months) of the date on the original bill.

For Questions or More Information

For questions about your Good Faith Estimate, you may contact:

Libby Coufal, LCSW
Coufal & Co., Thoughtful Therapy for Life Transitions

Libby.LSCW@coufal.co

You can also visit:

https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/avoid-surprise-healthcare-expenses

for more information about your rights under the No Surprises Act.

Important Note

The Good Faith Estimate is not a contract and does not require you to receive services. It is an estimate of expected charges based on the information known at the time it is created.