Good Faith Estimate

Gladys Newbury, LCSW

Your Right to a Good Faith Estimate

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

This is called a Good Faith Estimate and is intended to help you understand what the charges for your mental health care services might be before you receive them.

Your Right to a Good Faith Estimate

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

This is called a Good Faith Estimate and is intended to help you understand what the charges for your mental health care services might be before you receive them.

Good Faith Estimate for Psychotherapy Services

If you are paying for services out-of-pocket and not using health insurance, you are entitled to a Good Faith Estimate that outlines the cost of your treatment. This estimate will be provided to you in writing prior to your first session and upon request at any time during your care.

While it is difficult to predict exactly how many sessions a client may need, your Good Faith Estimate will include:

  • Your provider’s name (Gladys Newbury, LCSW)

  • The frequency and type of services anticipated

  • The estimated total cost based on your treatment plan

Example Cost Estimate:

  • Initial Intake Assessment (90791): $180

  • Ongoing Individual Psychotherapy (90837, 53+ min): $150 per session

  • Shorter Psychotherapy Session (90834, 38–52 min): $140 per session
    Brief Check-In or Consultation (90832, 16–37 min): $120 per session

Note: These are standard rates. Your actual estimate will reflect your specific services and treatment goals.

Your Rights Under the No Surprises Act

  • You have the right to receive a Good Faith Estimate in writing at least 1 business day before your service if requested or if you are a new client paying privately.

  • You may ask your provider for a Good Faith Estimate at any time.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

For More Information or to Dispute a Bill:

If you believe you have been wrongly billed or have questions about your rights under the No Surprises Act, you may contact:

Centers for Medicare & Medicaid Services (CMS)
Phone: 1-800-985-3059
Website: www.cms.gov/nosurprises

If you have questions about this notice or your estimate, feel free to contact:


Gladys Newbury, LCSW
(406) 219-8581

info@gladyslcswcounseling.com