Notice of Your Rights and Protections Against Surprise Medical Bills

(OMB Control Number: 0938-1401) 

Effective January 1, 2022, under the federal No Surprises Act, you have the right to receive a “Good Faith Estimate” (GFE) of the expected costs of your mental health care. 

 • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like psychotherapy sessions, assessments, and other related services. 

• If you are uninsured or choose not to use your insurance, we will provide you with a written Good Faith Estimate of expected charges. 

• You will receive your Good Faith Estimate in writing at least 1 business day before your scheduled service. You may also ask for a Good Faith Estimate before you schedule. 

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

• Make sure to save a copy or picture of your Good Faith Estimate. 

 Visit www.cms.gov/nosurprises Or call 1-800-985-3059 

Although we currently offer some in person therapy sessions in the Silicon Valley, we are primarily serving clients throughout California via telehealth through a Zoom HIPAA compliant platform. Our clients have found telehealth to be equally as effective as in person therapy sessions. 

Details and consent forms are available during the free information call, as well as through our client portal