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GOOD FAITH
ESTIMATE POLICY

CASTILLO PSYCHOTHERAPY  & COUNSELING

CASTILLO PSYCHOTHERAPY & COUNSELING PLLC

Under the No Surprises Act, you have the right to receive a Good Faith Estimate explaining how much your mental health care may cost.

Who Is Entitled to a Good Faith Estimate

You have the right to receive a Good Faith Estimate if you:

  • Do not have health insurance

  • Choose not to use insurance (self-pay)

  • Request an estimate, even if you plan to use insurance
     

This estimate is provided before services begin and reflects the expected cost of services over a 12-month period.

What Is a Good Faith Estimate

A Good Faith Estimate is not a bill. It is an estimate of expected charges for psychotherapy services based on:

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  • The type of services discussed

  • The expected frequency of sessions

  • Your individual treatment needs
     

Actual costs may be higher or lower depending on changes in treatment frequency, duration, or additional services requested.

What Services May Be Included

A Good Faith Estimate may include estimated costs for services such as:

  • Initial intake assessment

  • Individual psychotherapy sessions

  • Ongoing treatment sessions

  • Optional services requested by the client (such as documentation or evaluations)
     

Non-covered services, such as Emotional Support Animal (ESA) evaluations or letters, are typically billed separately and may be included only if requested.

Your Right to Dispute Charges

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

You may initiate a dispute through the U.S. Department of Health and Human Services (HHS) within 120 days of receiving the bill.

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More information about the dispute process is available at:
https://www.cms.gov/nosurprises

Requesting a Good Faith Estimate

You may request a Good Faith Estimate:

  • Before scheduling services

  • At any point during treatment

  • If your treatment plan or frequency changes
     

To request a Good Faith Estimate, please contact:

Castillo Psychotherapy & Counseling PLLC
Phone: (832)-271-2497
Email: alessa@castillopsychotherapy.com

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