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You have the right to receive a Good Faith Estimate explaining how much your therapy services will cost. This policy is part of the No Surprises Act, a federal law that protects individuals from unexpected medical bills when paying out of pocket.

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What Is a Good Faith Estimate?

A Good Faith Estimate (GFE) outlines the expected cost of services when you are:

• Paying privately (self-pay) without using insurance
• Out-of-network and not submitting to insurance
• Requesting an estimate for budgeting or transparency

This estimate helps you understand the financial commitment before starting services.

What You Can Expect

If you are a self-pay client, I will provide a Good Faith Estimate:

• In writing before your first session
• Or at any time upon request
• The estimate will include the cost per session

Please note that this is only an estimate. Your actual total cost may vary depending on how many sessions you attend, how often we meet, and any changes in your treatment needs.

Your Rights Under the Law

• You have the right to receive your Good Faith Estimate in writing.
• You can ask for a revised estimate at any time.
• If you receive a bill that is $400 or more above your Good Faith Estimate, you may dispute it through the U.S. Department of Health and Human Services (HHS).

For more information, visit:
www.cms.gov/nosurprises

If you are a current or prospective client and would like to request a Good Faith Estimate, please contact me at
📧 info@jenelledeilgat.com
📞 (619) 722-0511