Good Faith Estimate Notice

(No Surprises Act)

Last updated: December 27, 2025

Under the law, health care providers must give clients who are uninsured or who choose not to use their insurance (self-pay) a Good Faith Estimate (GFE) of expected costs.

This notice explains your rights and how this applies to therapy services.

Your Right to Receive a Good Faith Estimate

You have the right to receive a written Good Faith Estimate for the total expected cost of therapy services when:

• You are not using insurance,

• You are uninsured, or

• You choose to self-pay, even if you have insurance.

You may request a Good Faith Estimate at any time, before scheduling or at any point during your work with me. Once requested, a Good Faith Estimate will be provided within the timeframes required by federal law.

What the Estimate Includes

Your Good Faith Estimate will outline:

• The per-session fee

• The estimated number of sessions

• Any additional expected costs (if applicable)

Therapy needs vary from person to person, so the estimate is not a contract or a guarantee of treatment length. You are free to stop therapy at any time.

If Your Costs Change

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through the U.S. Department of Health and Human Services. You must initiate the dispute within 120 days of receiving the bill. Keep a copy of your Good Faith Estimate for reference.

How to Ask for a Good Faith Estimate

You can request a GFE by emailing:
admin@inharmonymhc.com

or mentioning it during intake or scheduling.

For More Information

For more information about your right to a Good Faith Estimate, visit the U.S. Centers for Medicare & Medicaid Services at www.cms.gov/nosurprises or call 1-800-985-3059.