Under the federal No Surprises Act, clients who do not have health insurance—or who choose not to use their health insurance to pay for services—have the right to receive a written Good Faith Estimate explaining the expected cost of their care.

A Different Lens Counseling, LLC will provide a Good Faith Estimate when you schedule services at least three business days in advance or whenever you request one. Because psychotherapy is individualized, your estimate will be based on the anticipated session fee, frequency of appointments, and expected duration of services at the time the estimate is prepared. You and your therapist may decide to change the frequency or duration of treatment based on your clinical needs. If the anticipated scope or cost of services changes, you may receive an updated estimate.

A Good Faith Estimate is not a bill or a contract. It does not require you to receive services from A Different Lens Counseling, LLC, and the actual number or type of services you receive may differ from the estimate.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may be eligible to use the federal patient-provider dispute resolution process. Beginning a dispute will not negatively affect the quality of care you receive.

Please keep a copy of your Good Faith Estimate for your records. To request an estimate or ask questions about the expected cost of services, contact A Different Lens Counseling, LLC at 321-287-6919 or [email protected].

For more information about your rights under the No Surprises Act, visit the Center for Medicare & Medicaid Services or call the No Surprises Help Desk at 1-800-985-3059.