One of the more useful consumer protections in healthcare arrived quietly in 2022 and most people have never heard of it, including many patients who are handed the document and file it without reading.
If you are paying for therapy without using insurance, you have a legal right to know what it will cost — in writing, before you start.
What the Good Faith Estimate is
Under the federal No Surprises Act, health care providers must give uninsured and self-pay patients a written estimate of expected charges before providing services.
It applies to therapy the same as to any other health service. It is not optional, and it is not something you have to ask for — though you should ask if it is not offered.
Who it covers: anyone without insurance, and anyone with insurance who chooses not to use it for this service. That second category is larger than people realize; many people pay privately for therapy specifically to keep it out of an insurance record.
Who it does not cover: patients whose care is being billed to insurance. Those situations are governed by your plan's benefits instead.
What it has to include
A compliant estimate contains:
- The provider's name, address, and identifiers
- A description of the service — for therapy, typically an initial assessment and ongoing individual, couples, or family sessions
- The specific billing codes involved
- The expected charge for each service
- The expected total, based on an anticipated course of care
- The date it was issued
For ongoing therapy, providers generally estimate based on a projected number of sessions over a defined period — for example, weekly sessions for twelve weeks — with a note that the actual number will depend on your needs and will be reviewed with you.
The $400 rule
This is the part worth knowing.
If your final bill exceeds the Good Faith Estimate by $400 or more, you have the right to dispute it through a federal patient-provider dispute resolution process.
You generally must initiate the dispute within 120 days of receiving the bill. The process involves an independent third-party reviewer, and there is a modest administrative fee.
Two practical implications. First, get the estimate and keep it. Second, if your care extends well beyond what was estimated, ask for an updated estimate as you go — this is normal and it protects both sides.
Why it is genuinely useful for therapy
Therapy is unusual among health services in that it is ongoing and open-ended, which makes cost anxiety a real barrier for many people.
A written estimate converts a vague, indefinite expense into a number you can plan around. That has practical value: people who know that twelve sessions will cost a specific amount are considerably more likely to start, and considerably less likely to quit abruptly out of financial worry.
It is also a good prompt for a conversation most people avoid having. It is entirely appropriate to ask a therapist how long they expect this to take and what would signal that you are done.
What our rates actually are
We publish these because vagueness about cost helps nobody.
- Licensed clinicians — $150 per 50-minute session
- Associate clinicians (CSW-I, CPC-I, MFT-I, working under supervision) — $125 per 50-minute session
- Graduate-level student clinician — $25 to $60 per 50-minute session
If you are self-pay, you receive a written Good Faith Estimate before your first session, covering your anticipated course of care.
If you are using insurance, we verify your benefits first and tell you your expected copay or coinsurance, whether your deductible applies, and whether telehealth is covered at the same rate. We are in network with most major plans, including Aetna, Cigna, Anthem Blue Cross Blue Shield, UnitedHealthcare, Health Plan of Nevada, and Silver Summit.
Questions worth asking any provider
Before you start with anyone:
- What is the fee per session, and how long is a session?
- Do you offer a reduced rate, and what determines eligibility?
- What is your cancellation policy, and what is the fee?
- Do you charge for phone calls, letters, or documentation between sessions?
- If I use insurance, what is my expected out-of-pocket cost?
- Can I have a Good Faith Estimate in writing?
That last question is a reasonable one and any legitimate practice will answer it without hesitation. Reluctance is informative.
The cancellation policy deserves attention
It is the most common source of unexpected charges in therapy, and it is not covered by the Good Faith Estimate.
Most practices require 24 or 48 hours' notice and charge a fee for late cancellations and no-shows. Insurance does not cover these — they are your responsibility.
This catches people out, particularly shift workers whose schedules change without warning. Ask about it before you start, and ask specifically whether an unexpected shift change counts as an exception.
If cost is the obstacle
Worth checking before concluding therapy is out of reach:
- Nevada Medicaid covers behavioral health, and eligibility is broader than many people assume
- Nevada Health Link marketplace plans, including Silver Summit and Ambetter, include behavioral health
- Your employer's EAP, which typically provides several free sessions with no wait — most employees at large Las Vegas employers have one and never use it
- Reduced-rate options, including associate and student clinicians
- HSA and FSA funds, which can be used for therapy
Cost should not be a mystery
The reason this protection exists is that healthcare pricing has historically been opaque in a way it is in almost no other industry.
You are entitled to know what something costs before you agree to it. If you would like the number for your situation, request an appointment and we will give it to you in writing before you sit down for a first session.