Good Faith Estimate

Your Right to Know What Therapy May Cost

At Reflections Therapy, we believe in transparency and fairness. If you are paying out of pocket or choosing not to use insurance, you have the right to receive a written estimate of what your services will cost, before you begin. This is called a Good Faith Estimate , and it is part of the federal No Surprises Act.

What You Can Expect

• A written estimate for the total expected cost of services

If you schedule 3–9 business days ahead, your estimate is provided within 1 business day after scheduling. If you schedule 10 or more business days ahead, it is provided within 3 business days after scheduling. If you request an estimate before scheduling, it is provided within 3 business days of your request.

• Clear communication with no surprise billing

This estimate will include the expected cost of therapy sessions, based on the frequency we agree on during your consultation. While it is not a contract or exact bill, it gives you a clear sense of what to expect.

If You Have Questions or Concerns

If you receive a bill that is $400 or more above your estimate, you have the right to dispute the charges. To learn more about your rights, visit www.cms.gov/nosurprises or call 800-985-3059.