Your Right to a Good Faith Estimate Under the No Surprises Act
At everhope, llc, we believe that clients should have clear, transparent information about the cost of
counseling services before treatment begins.
Under the
No Surprises Act
, individuals who do not have health insurance, choose not to use their health
insurance benefits, or are considered self-pay clients, have the right to receive a
Good Faith Estimate
(GFE)
of the expected charges for scheduled healthcare services.
What Is a Good Faith Estimate?
A Good Faith Estimate is a written estimate of the anticipated cost of counseling services based on the
information reasonably available at the time it is prepared. It includes the expected charges for services
provided by everhope, llc.
Psychotherapy Services
Because mental health treatment is highly individualized, it is generally not possible to predict with
certainty the total cost of care. The duration, frequency, and type of counseling services are determined
collaboratively between you and your clinician and may change over the course of treatment based on
your needs, goals, progress, and clinical recommendations.
Your Good Faith Estimate is therefore an estimate—not a contract, guarantee, or commitment regarding
the total cost of treatment. Actual charges may vary if your treatment plan changes or if additional
clinically appropriate services are provided.
Your Rights
As a self-pay client, you have the right to:

Receive a Good Faith Estimate before your first scheduled service or upon request.

Ask questions about your estimated costs before beginning treatment.

Request an updated Good Faith Estimate if your treatment plan changes significantly.

Retain a copy of your Good Faith Estimate for your personal records.
If Your Bill Is Higher Than Your Estimate
If you receive a bill that is
at least $400 more
than your Good Faith Estimate, you may have the right to
initiate the federal patient-provider dispute resolution process.
Questions regarding the federal Good Faith Estimate requirements or the patient-provider dispute
resolution process may be directed to the Centers for Medicare & Medicaid Services (CMS).
For additional information, please visit:
https://www.cms.gov/nosurprises
Questions
If you have questions regarding your Good Faith Estimate, our fees, or payment policies, please contact
everhope, llc before your appointment. We are committed to providing clear and transparent information
about service costs and will be happy to answer your questions