Good Faith Estimate - IHFT

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Tanya A. Alkhaliq, LMFTA

Marriage & Family Therapist Associate

Supervised by Dr. Tia Crooms, LMFT

GOOD FAITH ESTIMATE NOTICE

As required under the No Surprises Act, you have a right to a good faith estimate for services if you ae not using insurance

Your Rights

If you are not using insurance (self-pay), you can request a Good Faith Estimate of expected charges for items and services.

At Inner Healing Family Therapy, PLLC, we offer this to every new client after filling out the paperwork with expected totals for weekly, bi-weekly, and monthly therapy for the entire year.

Please keep in mind, these are ESTIMATES. If therapy sessions last 90-minutes or 75-minutes instead of 60-minutes, the estimate could be greatly increased. If therapy sessions consistently call for additional time, a new Good Faith Estimate will be administered.

What the Estimate Includes

A Good Faith Estimate will include the expected charges for therapy services based on information known at the time of the request. It is not a guaranteed total. Actual charges may vary.

When Charges Differ

If you receive a bill that is $400 or more than your Good Faith Estimate, you have the right to dispute the charges.

To learn more or to dispute:

www.cms.gov/nosurprises
1-800-985-3059

How to Request an Estimate

You may request a Good Faith Estimate before scheduling services or at any time during treatment.

Inner Healing Family Therapy, PLLC, offers this estimate before services are rendered; however, if sessions are consistently longer due to the depth of services and management of issues, a re-issue will be given.

To receive a new copy of a lost estimate, please check the portal documents signed at the beginning of therapy OR check your Ivy Pay receipt.

Beginning therapy can feel vulnerable, but it can also be the beginning of meaningful healing and change. Our goal is to walk alongside clients as they build clarity, emotional stability, and stronger relationship.

You do NOT have to navigate these spaces of growth and development alone!