Good Faith Estimate.

Your right to a Good Faith Estimate

Under the federal No Surprises Act (effective January 1, 2022), health care providers must give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including psychotherapy. Your provider must give you a Good Faith Estimate in writing at least one business day before your service. You can also ask your provider for a Good Faith Estimate before you schedule a service.

What the estimate includes

Your Good Faith Estimate will include:

• The name and license or registration number of the clinician who will be providing your care
• An itemized list of the expected services with their diagnostic and service codes
• The expected charge for each service
• An estimated total for the period covered by the estimate

Because the course and duration of psychotherapy vary from person to person, an estimate is our best projection based on the information available at the time. It is not a guarantee of the number or cost of sessions you will ultimately need.

Our current session fees

For reference, our standard fees are:

• Enid Wilson, LMFT — $200 per individual session; $225 per couples or family session
• Associate clinicians (registered AMFTs and APCCs) — $160 per session

These rates apply to sessions of 45–53 minutes. Longer sessions, intake sessions, and clinical consultations may be billed at different rates, which will be reflected on your Good Faith Estimate.

When you’ll receive one

You will receive a Good Faith Estimate:

• At intake, before your first session, if you are uninsured or choosing not to use insurance
• Upon request, at any point in your care
• At least one business day before a scheduled service, if you request one before scheduling

Your right to dispute a bill

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 federal Patient-Provider Dispute Resolution process.

To start the dispute process, you generally must file your dispute within 120 calendar days of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the amount on your Good Faith Estimate. If the agency disagrees with you and agrees with the provider, you will have to pay the higher amount.

Filing a dispute will not adversely affect the quality of health care services you receive from Pinnacle Counseling Group.

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

How to request an estimate

You may request a Good Faith Estimate by:

Telephone: (916) 990-2326
Email: [email protected]
Mail: 2335 American River Drive, Suite 305, Sacramento, CA 95825

Please keep a copy of your Good Faith Estimate in a safe place. You may need it if you are billed a higher amount.