Getting Started
Your Right to a Good Faith Estimate
If you pay for therapy yourself, federal law gives you the right to know what your care is expected to cost before it starts. That right comes from the No Surprises Act, and it applies when you are uninsured or are not using insurance to pay for your sessions. This guide explains how a Good Faith Estimate works with Marie Sarte, LCSW.
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What a Good Faith Estimate Is
A Good Faith Estimate is a written estimate of the expected charges for the care you plan to receive. Under the No Surprises Act, health care providers, including therapists, need to give one to patients who do not have insurance or who are not using insurance. For therapy, an estimate usually names the type of session, the fee for each session, and an expected number of sessions over a stated period. It is a planning document, not a contract, and it does not commit you to any number of appointments.
Who Can Ask for One
You can ask for a Good Faith Estimate if you are uninsured or if you are paying for sessions without having your plan billed. Paying privately counts. If you have a PPO plan and intend to submit monthly superbills to your insurance for out-of-network reimbursement, you are still paying Marie directly for each session, so you can ask for an estimate as well. For a teen, the parent or guardian arranging care can request it.
When You Should Receive It
Timing depends on when you schedule. If you book a session at least 3 business days ahead, you should receive the estimate within 1 business day after scheduling. If you book at least 10 business days ahead, it should arrive within 3 business days after scheduling. If you ask for an estimate before scheduling anything, it should arrive within 3 business days of your request. The estimate comes in writing, and you are welcome to ask questions about anything on it.
If a Bill Is Higher Than Expected
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. The federal patient-provider dispute resolution process is available within 120 days of the date on the bill. Save a copy or a photo of your estimate so you have it if a question ever comes up. These protections come from federal law. For more information about your rights, visit cms.gov/nosurprises or call 1-800-985-3059.
Asking Marie for an Estimate
To request an estimate, use the contact page, or bring it up during your free 15-minute consultation. Individual therapy is $200 and couples or family therapy is $225, and each session is 50 minutes. Sessions are usually weekly, online for clients located in Oregon or in person at 1125 SE Market St, Portland, OR 97214. Please give at least 48 hours' notice to cancel. The estimate will reflect the kind of sessions and the schedule you talk through together.
Questions You May Have
Does an estimate mean I have to book a set number of sessions?
No. The estimate is a planning tool, not a commitment. You can change your plans, pause, or stop at any point, and you can ask for a new estimate if the kind or number of sessions changes.
Can I ask for an estimate if I will use my PPO benefits?
Yes, if you are paying Marie directly and submitting superbills to your plan yourself. Your plan decides separately whether and how much to reimburse, so check your out-of-network benefits with the plan.
Marie Sarte, LCSW
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