Good Faith Estimate

Notice Required Under the No Surprises Act

Your Right to a Good Faith Estimate

Under the No Surprises Act, you have the right to receive a Good Faith Estimate of the expected cost of your care before your first appointment, and upon request at any time.

What Is a Good Faith Estimate?

A Good Faith Estimate is a written estimate of the expected cost of services you may receive. It is not a contract and does not require you to obtain services from this provider. The actual cost of services may differ from the estimate depending on the nature, frequency, and duration of treatment.

Because Megan Bathen-Gonzalez Psychotherapy is a fully private-pay practice that does not bill insurance directly, all clients are considered self-pay for the purposes of this notice.

Standard Session Fees

Individual Therapy — 50 minutes — $225
Couples Therapy — 50 minutes — $250
Family Therapy — 50 minutes — $275
Free Initial Consultation — 15 minutes — $0

A limited number of sliding scale spots may be available. Please inquire directly if cost is a barrier to care.

Estimated Cost Over Time

The total cost of therapy depends on frequency and duration, which is determined collaboratively. Most clients attend weekly or biweekly sessions.

Individual Therapy: $2,700 (12 weeks) / $5,850 (6 months) / $11,700 (1 year)
Couples Therapy: $3,000 (12 weeks) / $6,500 (6 months) / $13,000 (1 year)
Family Therapy: $3,300 (12 weeks) / $7,150 (6 months) / $14,300 (1 year)

These are estimates only. There is no requirement to commit to a specific number of sessions in advance.

Out-of-Network Reimbursement

This practice does not bill insurance directly, but many clients with PPO plans may be eligible for partial reimbursement through their out-of-network benefits. A superbill can be provided upon request for you to submit to your insurance company.

To check your out-of-network benefits before scheduling, use the Mentaya tool at mentaya.com. Many PPO clients receive 40 to 80% back on sessions. Reimbursement is not guaranteed and depends on your specific plan.

Your Rights Under the No Surprises Act

You have the right to:

Receive a Good Faith Estimate in writing at least one business day before your scheduled service
Request a Good Faith Estimate before scheduling any service
Dispute a bill that is $400 or more above the Good Faith Estimate you received

If you receive a bill that is $400 or more above your Good Faith Estimate, you may be eligible to dispute it through the federal Patient-Provider Dispute Resolution process. For more information visit cms.gov/nosurprises or call 1-800-985-3059.

Receiving a Good Faith Estimate does not limit your ability to dispute a bill, require you to obtain services from this provider, or waive any rights you may have.

Questions?

Megan Bathen-Gonzalez Psychotherapy, LMFT
LMFT License #150616 | NPI: 1720643299
Los Gatos, CA
megan@meganbathen-gonzalezpsychotherapy.com
(408) 341-9146