Your Right to a Good Faith Estimate

At Palomares Therapy, we believe that understanding the financial aspects of therapy is an important part of making informed decisions about your care.

Under the federal No Surprises Act, individuals who do not have health insurance or who are not using their health insurance to pay for services have the right to receive a Good Faith Estimate of their expected healthcare costs

A Good Faith Estimate is a written document outlining the anticipated costs of your therapy services before they are provided.

For ongoing psychotherapy, an individualized estimate may include the expected frequency of sessions, session fees, anticipated number of appointments, and projected total cost over a specified period of care.

Because psychotherapy is individualized, the duration and frequency of treatment may change depending on your needs and goals. A Good Faith Estimate is not a bill or a contract requiring you to receive services.

If you are uninsured or not using insurance to pay for your care, you have the right to request a Good Faith Estimate before scheduling therapy.

Federal guidelines establish the following timeframes:

• If you schedule services 3–9 business days in advance, you should receive a written estimate within 1 business day after scheduling.
• If you schedule services 10 or more business days in advance, you should receive a written estimate within 3 business days after scheduling.
• If you request an estimate before scheduling, you should receive it within 3 business days of your request.

You may request a Good Faith Estimate at any time.

Your Good Faith Estimate reflects the services and charges reasonably anticipated at the time it is prepared. Your actual treatment needs and costs may change.

If you receive a bill from a provider that is at least $400 more than that provider’s Good Faith Estimate, you may be eligible to dispute the bill through the federal patient-provider dispute resolution process.

Generally, a dispute must be initiated within 120 calendar days of receiving the initial bill.

To request an individualized Good Faith Estimate for therapy services at Palomares Therapy, please contact our office or speak directly with your treating clinician.

Palomares Therapy
210 S. Orange Grove Blvd.
Pasadena, CA 91105
(626) 209-9055
danielle@palomarestherapy.com

For additional information about your rights under the No Surprises Act, please visit the Centers for Medicare & Medicaid Services website or call 1-800-985-3059.

Good Faith Estimate Notice: If you are uninsured or not using health insurance to pay for therapy, you have the right to receive a written estimate of expected treatment costs.
Learn more about your rights and how to request an estimate.