Good Faith Estimate

Under the No Surprises Act, health care providers are required to give clients who do not have insurance, or who are not using insurance, an estimate of expected charges for medical services, including mental health services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy sessions.

This right applies to you as a client of Whole Wellness Counseling, PLLC because this practice is private-pay and does not submit claims to insurance companies.

Before beginning treatment, you will receive a written Good Faith Estimate that includes your agreed session fee, the expected frequency of sessions based on your treatment plan, and the anticipated total cost of care over a defined period.

The estimate is based on the information available at the time it is prepared. It reflects the fee tier you have selected and the session frequency we have discussed. It is not a guarantee of the total cost of your care, as treatment needs may change over time.

Your Good Faith Estimate will be updated if your agreed fee, session frequency, or treatment plan changes in a way that materially affects the anticipated cost.

Whole Wellness Counseling offers a self-selected sliding-scale fee structure. Current session fees range from $125 to $225 per session, depending on the fee tier selected by the client.

Standard Fee: $225 per session

Supported Fee: $175 per session

Community Access Fee: $125 per session

The fee you are charged will be the rate agreed upon at the start of treatment or as subsequently modified by mutual written agreement.

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 contact us to let us know the billed charges are higher than the Good Faith Estimate. You can ask us to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

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 of the date on the original bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

If you have questions about your Good Faith Estimate or would like to request one before beginning treatment, please contact us through the consultation portal on our Contact page.

Whole Wellness Counseling, PLLC — Georgetown, Texas