Aligned Therapy Collective

GOOD FAITH ESTIMATE

Under the 2021 No Surprises Act, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical services, including psychotherapy.

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

Make sure your health care provider, Alyssa Autterson, Licensed Professional Counselor Associate #98429 (Texas), gives you a Good Faith Estimate in writing at least 1 business day before your medical service. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

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

Make sure to save a copy or take a picture of your Good Faith Estimate.

Based on a fee of $150 per session, if you attend one psychotherapy session per week, your estimated charge would be $600 for four sessions over the course of one month. If you attend therapy biweekly, your estimated cost would be $300 over the course of one month. Your total estimated charges will increase according to the number of sessions and length of treatment. We will work collaboratively to ensure you are only attending sessions as needed, as deemed effective for you, and until you have reached your therapy goals.

Session frequency will be determined in your initial session and as we set your therapy goals. Your goals will determine how many sessions you will need. Most clients begin with weekly sessions to dive into their story, build rapport, and gain momentum towards achieving their goals. Clients will only consent to one session at a time so they will not be “surprised” by any cost for services they did not agree to.

Retain a copy of this estimate for your records in the event you are billed for a higher amount and wish to dispute it. Initiating a dispute with your provider will not impact the quality of services provided.

For more questions regarding the Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-368-1019.

Disclaimer: This estimate includes cost of reasonably expected services related to your care. It does not include any unexpected unknown expenses that may arise during treatment including administrative fees, legal fees, preparing progress notes, consultation with case managers and other care specialists, etc.