Holding Space with Kay
Your rights

Good Faith Estimate

If you are uninsured, or insured but choosing not to use your insurance, federal law gives you the right to know what your care will cost before you receive it.

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
  • If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

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.

What this means at this practice

This is a private-pay practice, so the Good Faith Estimate applies to everyone I work with. You will receive one in writing before we begin, and you can ask for an updated estimate at any point.

Individual session$55 · 50 minutes, by telehealth
Couples session$70
Initial consultationFree · 15 minutes, no charge and no obligation
Sliding scaleA limited number of reduced-fee places are available. Asking will not change how you are treated.
Payment methodsVisa, Mastercard, PayPal, Zelle, Apple Cash, and HSA cards

Because counseling is ongoing rather than a single procedure, your estimate is based on the number of sessions we expect at the outset — commonly weekly or fortnightly. If we agree to meet more or less often, the estimate can be revised.

An estimate is not a contract. It does not oblige you to a number of sessions, and you may stop at any time. It also does not include services from anyone other than me — a psychiatrist or physician you see separately would provide their own.

How to request one

You do not need to fill in a form. Ask at any point — during your free consultation, by phone, or by email — and I will send it in writing.

If your bill is higher than your estimate

If you are billed at least $400 more than your Good Faith Estimate, you may dispute the charge through the federal Patient-Provider Dispute Resolution process. You have 120 calendar days from the date of the bill to start a dispute. Details are at cms.gov/nosurprises/consumers.

Keep a copy of your estimate. You will need it if you ever wish to dispute a bill.

The notice above uses the model language published by the Centers for Medicare & Medicaid Services (revised August 2023). Last reviewed 20 August 2026.