Good Faith Estimate

Healthcare providers are now required by federal law to provide self-pay clients with Good Faith Estimates for services that will be provided.

The total cost of therapy depends on how long an individual stays in the therapeutic process. This makes it difficult to predict the total cost of therapy. The figures below represent the amount paid for a few examples of hypothetical treatment durations:

8 Individual / Couple therapy sessions at $180 = $1,440

12 Individual / Couple therapy sessions at $180 = $2,160

20 Individual / Couple therapy sessions at $180 = $3,600.

A specific Good Faith Estimate may be obtained from your therapist at your request.

Additional costs associated with your time at therapy may occur in rare circumstances, such as fees associated for providing health records and treatment plans, appearing in court, or engaging with attorneys. As these are very infrequent fees they are not included in this example, but can be provided upon request.

Your Rights:

If you are billed more than $400 over amount provided in a Good Faith Estimate, you may have the right to dispute the bill. You may discuss directly with your therapist or directly with the Kintsugi Institute’s administration to let them know the billed charges are higher than the Good Faith Estimate. You can ask for an update to the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. If you dispute your bill, Kintsugi Institute cannot move the bill for the disputed item or service into collection or threaten to do so, or if the bill has already moved into collection, Kintsugi Institute has to cease collection efforts. Kintsugi Institute must also suspend the accrual of any late fees on unpaid bill amounts until after the dispute resolution process has concluded. Kintsugi Institute cannot take or threaten to take any retributive action against you for disputing your bill. If you desire to use the federal dispute resolution process there is a $25 fee. If the Selected Dispute Resolution (SDR) entity reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate, reduced by the $25 fee. If the SDR entity disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises/consumers or call 1- 800-985-3059.