Good Faith Estimate
Your Right to Receive a Good Faith Estimate
Under the No Surprises Act, health care providers are required to provide individuals who do not have insurance or who are not using insurance with a Good Faith Estimate of expected charges for health care services.
You have the right to receive a Good Faith Estimate explaining the expected cost of your mental health services before you begin treatment.
The Good Faith Estimate will include reasonably expected costs for services provided by Mary O. Smith, DSW, LCSW.
Please note that the estimate is based on the information available at the time it is provided. Actual services or treatment recommendations may change based on your individual needs, and the final cost may differ from the estimate.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.
You may request a Good Faith Estimate before scheduling services or at any time during treatment.
For additional information about your rights under the No Surprises Act, please visit www.cms.gov/nosurprises.
If you have questions about fees or would like to request a Good Faith Estimate, please contact:
Mary O. Smith, DSW, LCSW
For more information about your rights under the No Surprises Act and Good Faith Estimates, please visit the official Centers for Medicare & Medicaid Services (CMS) website: Know Your Rights Without Insurance
Current Private-Pay Fees
Initial Intake Assessment: $200
Individual Therapy Session (50 minutes): $175
ADHD Coaching (30 minutes): $60
Crisis Psychotherapy: Fees vary based on appointment length and clinical need.
A personalized Good Faith Estimate will be provided before services begin and will reflect your anticipated course of treatment.