Good Faith Estimate (GFE)

Purpose Path Counseling Services recognizes that every client’s therapeutic journey is unique. How long you need to engage in therapy and how often you attend sessions will be influenced by many factors including:

  • Your schedule and life circumstances.

  • Therapist availability.

  • Ongoing life challenges.

  • The nature of your specific challenges and how you address them.

  • Personal finances.

You and your therapist will continually assess the appropriate frequency of therapy and will work together to determine when you have met your goals and are ready for discharge, and/or a new “Good Faith Estimate” (GFE) will be issued should the frequency of session(s) or needs change.  As related, you may request a new GFE at any time in writing during your treatment.  

Disclaimer

  • Under the No Surprises Act (H.R. 133 – which went into effect on January 1, 2022), health care providers are required to give clients who do not have insurance or who are electing to not use insurance, an estimate of the bill for related services.

  • You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.

  • Under the law, 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 items and services.

  • This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. Your provider may recommend additional services that are not reflected in this Good Faith Estimate.

  • The Good Faith Estimate is only an estimate—actual items/ service charges may differ.  The Good Faith Estimate does not include any unknown or unanticipated costs that may arise and are not reasonably expected during treatment due to unforeseen events.  You could be charged more if complications or special circumstances occur.  If this happens, federal law allows you to dispute (appeal) the bill. 

  • Other potential items and/ or services associated with therapy charges may include but is not limited to no show/ late cancellation fee(s), record request(s), letter writing(s), legal fee(s)/ court attendance(s), professional collaboration(s), and in-between session supports).  These potential items / services and associated fee(s) are discussed further within the Informed Consent documentation and should these items / services be initiated a new Good Faith Estimate will be provided.  The Good Faith Estimate does not obligate the client to obtain listed items or services.

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

  • Make sure your health care provider gives you a Good Faith Estimate in writing within the following timeframes; if the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling; if the service is scheduled at least 10 business days before the appointment date, no later than three (3) business days after the date of scheduling; if the uninsured or self-pay patient requests a good faith estimate (without scheduling the service), no later than three (3) business days after the date of the request. A new good faith estimate must be provided, within the specified timeframes if the patient reschedules the requested item or service. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

  • The No Surprises Act has a universal waiver form required. You may view the PDF of the waiver by clicking here.

  • This is the public disclosure of the “Good Faith Estimate”. Click here to view.

  • You are encouraged to speak with your provider at any time about any questions you may have regarding your treatment plan, or the information provided to you in this Good Faith Estimate.

  • A Good Faith Estimate is for your awareness ONLY. It does NOT involve you needing to make any type of commitment.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059. Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-368-1019.