Good Faith Estimate

Understanding Your Rights and Expected Costs

Your Right to a Good Faith Estimate

Under the No Surprises Act, health care providers are required to provide a Good Faith Estimate of expected charges for services to individuals who are uninsured or who plan to submit claims to their health insurance for out-of-network coverage.

What You Can Expect

Service Information

At Radical Roots Psychotherapy, we provide the following services with associated fees:

  • Individual Therapy (45-min sessions): $235

  • Family Therapy (60-min sessions): $270

  • IFS-EMDR Therapy (75-90 min sessions): $300

  • ADHD Assessment & Treatment: [Specific fee structure]

Frequency of Services

  • Typical frequency: Weekly or bi-weekly sessions

  • Initial assessment period: 2-3 sessions

  • Treatment duration varies based on individual needs and goals

Additional Costs

  • Late cancellation fee (less than 48 hours notice): Full session fee

  • No-show fee: Full session fee

  • Documentation/letter writing: [Fee structure if applicable]

Understanding Your Estimate

  • This Good Faith Estimate shows the costs of services that are reasonably expected for your mental health care needs.

  • The estimate is based on information known at the time the estimate was created.

  • The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment.

  • Actual charges may differ from the estimate if additional services are needed or if the treatment plan changes.

Your Rights

  • You have the right to receive this Good Faith Estimate before your service.

  • You can request an updated estimate at any time.

  • You have the right to dispute a bill if charges substantially exceed the Good Faith Estimate.

  • The Good Faith Estimate is not a contract and does not require you to obtain the services from Radical Roots Psychotherapy.

Payment Information

  • Payment is due at the time of service

  • We accept:

    • Credit/debit cards

    • HSA/FSA cards

    • ACH bank transfer

    • Cash

    • PayPal

    • Venmo

    • Zelle

Insurance Information

While we do not accept insurance directly:

  • We can provide superbills for out-of-network reimbursement

  • You may submit these to your insurance company

  • Reimbursement rates vary by insurance plan

Sliding Scale Options

We offer a limited number of sliding scale spots for clients facing financial hardship. Please inquire about current availability and qualification criteria during your consultation.

Questions About Your Estimate?

If you have questions about this Good Faith Estimate, please contact us:

Additional Information

For more information about your rights under the No Surprises Act, visit: www.cms.gov/nosurprises

Note: This Good Faith Estimate is not a contract and does not obligate you to obtain services from Radical Roots Psychotherapy. It is provided to help you make an informed decision about your mental health care.