Good Faith Estimate

1. What Is a Good Faith Estimate?

A Good Faith Estimate is a written notice of the expected cost of your health care services. It is provided to you before your first appointment and updated as needed. The estimate includes the expected charges for the services you are scheduled to receive, including any associated fees.

You are entitled to receive a Good Faith Estimate if you are uninsured, or if you are insured but choose not to use your insurance benefits for your care (i.e., you are paying out of pocket).

2. Our Practice Information

3. Services and Expected Charges

The following are the standard fees for services provided by this practice. Your actual charges may vary depending on the specific services rendered during each session. A personalized Good Faith Estimate will be provided to you before your first appointment.

* Fees are subject to change. These fees apply to self-pay and out-of-network services. If you are using insurance, your actual cost will depend on your plan's benefits, deductible, and copay/coinsurance. Reduced-fee appointments may be available on a limited basis for self-pay clients; please see the Reduced-Fee Policy section below.

4. Insurance and Out-of-Network Benefits

This practice is in-network with select insurance plans, including Optum/UnitedHealthcare, Aetna, Blue Shield of California, and Carelon Behavioral Health. However, insurance coverage must be verified before your first appointment. Being listed as an in-network provider does not guarantee that your specific plan covers our services.

If you have out-of-network benefits, we can provide a superbill (itemized receipt) that you may submit to your insurance company for potential reimbursement. Reimbursement is not guaranteed and depends entirely on your plan's out-of-network benefits.

You are responsible for verifying your benefits and understanding your financial responsibility before beginning services. We encourage you to call the member services number on the back of your insurance card to confirm coverage.

5. Your Rights Under the No Surprises Act

• You have the right to receive a Good Faith Estimate in writing at least one (1) business day before your scheduled service.
• You may also request a Good Faith Estimate before scheduling 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.

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

6. Reduced-Fee Policy

A limited number of reduced-fee appointments are available for clients who are paying privately and not using insurance for the service. Fees are determined based on household income, household size, individual financial circumstances, and the availability of reduced-fee appointments.

If cost is a concern, please mention it when you reach out. No financial documentation is required to make an initial inquiry. A brief sliding-scale application may be required before a reduced fee is approved. Eligibility is reviewed periodically and approval is not guaranteed.

Sliding-scale fees cannot be applied to insurance copayments, coinsurance, or deductibles.

7. How to Request Your Good Faith Estimate

To request a personalized Good Faith Estimate before your first appointment, please contact us directly: