Good Faith Estimate

You have the right to receive a "Good Faith Estimate" explaining how much your care will cost.

Under the No Surprises Act (effective January 1, 2022), health care providers are required to provide patients who don't have insurance or are not using insurance with an estimate of the expected charges for medical and mental health services, including psychotherapy.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency health care items or services, upon request or when you schedule services. This includes related costs such as any assessments, sessions, or other services reasonably expected to be provided.

How This Applies to Our Work Together

Leah Rambush, LMFT, is a private-pay practice and does not bill insurance. If you are not using insurance to pay for therapy or therapy intensive services, you are entitled to a Good Faith Estimate.

I will provide you with a Good Faith Estimate in writing:

  • Within 1 business day of scheduling, if your service is scheduled at least 3 business days in advance;

  • Within 3 business days of scheduling, if your service is scheduled at least 10 business days in advance; and

  • Within 3 business days of your request, any time you ask for one before scheduling a service.

Your Good Faith Estimate will include the expected charges for the primary service (for example, individual therapy or a therapy intensive) and any other items or services reasonably expected to be provided along with it. Because therapy is often ongoing, your estimate reflects the expected charges based on our anticipated work together.

What You Should Know

  • You can ask me for a Good Faith Estimate before you schedule a service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

  • Keep a copy or photo of your Good Faith Estimate for your records.

Questions or Disputes

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

If you have questions about a Good Faith Estimate for services with Leah Rambush, LMFT, please contact me at connect@leahlmft.com.