Good Faith Estimate

(No Surprises Act)

Last updated December 2, 2025

Under the federal No Surprises Act (2022), clients who are not using insurance—or who are choosing to pay out-of-pocket—have the right to receive a Good Faith Estimate (GFE) explaining the expected cost of non-emergency healthcare services, including psychotherapy.

The purpose of the Good Faith Estimate is to help you understand and anticipate the cost of your care. This is not a bill. Actual services provided and total costs may vary.

Your Right to a Good Faith Estimate

You have the right to:

  • Receive a Good Faith Estimate in writing at least one business day before your first session.

  • Request a Good Faith Estimate at any time during treatment.

  • Receive a new or updated estimate if your treatment plan changes.

  • Dispute a bill that is $400 or more above the estimate you were provided.

This law applies to all clients choosing to pay privately (without insurance) or who are not using out-of-network benefits.

What a Good Faith Estimate Includes

Your estimate will include:

  • The therapist’s name, credentials, and license number

  • The service type (individual, couples, or family psychotherapy)

  • The session fee

  • The projected number of sessions, based on your goals

  • Any anticipated additional charges (e.g., late cancellation fees, paperwork requests)

  • A total estimated cost for 12 months of care

Therapy is highly individualized, so the actual number of sessions you choose to attend is always up to you.

Typical Rates for Psychotherapy

Your estimate will reflect your actual fees. Standard rates may include:

  • Individual Therapy: $200 per 50 or $300 for 75 minute session

  • Couples Therapy: $200 per 50 or $300 for 75 minute session

  • Extended Sessions (optional): $400 for 120 minutes

  • Late Cancellation / No-Show Fee: $Rate of fee for session if cancellation happens within 24 hours before the session.

These fees will be documented in your estimate and reviewed with you before beginning therapy.

How Long Therapy May Last

Every client’s needs are different. Your Good Faith Estimate may outline a typical treatment range, such as:

  • Short-term therapy: 8–15 sessions

  • Moderate-term therapy: 16–30 sessions

  • Longer-term depth or trauma therapy: 30+ sessions

You may choose to continue, pause, or end therapy at any time.

Disputing a Bill

If you receive a bill that is $400 or more above the Good Faith Estimate, you have the right to dispute it.

You may:

  1. Contact me to discuss the difference

  2. Ask for the bill to be reviewed

  3. You may also start a dispute process with the U.S. Department of Health & Human Services (HHS)

For more information or to begin a dispute, visit:
https://www.cms.gov/nosurprises
or call 1-800-985-3059

Requesting a Good Faith Estimate

You can request a Good Faith Estimate at any time.
To request one, contact:

Alive Within Therapy & Wellness
Jennifer Viscidy, LMFT #14950

Jen@alivewithintherapy.com

(916) 548-3044

895 Embarcadero Drive Suite 201, El Dorado Hills, CA 95762