Good Faith Estimate

Under the federal No Surprises Act, you have the right to receive a Good Faith Estimate of expected charges for medical and mental health services that you book without insurance, or that are not covered by your insurance.

If you are paying out of pocket (or partly out of pocket) for services at Lemon & Leaves Counseling, you can request a written Good Faith Estimate of what your services will likely cost. We provide one to all private-pay clients during intake — and on request at any time — at least one business day before your scheduled session.

A description of services to be provided, the expected duration and frequency of those services, the expected charges per session, and any other expected charges. The estimate is based on the information available at the time and may change as treatment unfolds.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through the federal Patient-Provider Dispute Resolution process. You have 120 days from receiving the bill to start the dispute. Visit cms.gov/nosurprises for the dispute form and details.

Email REPLACE@lemonandleavescounseling.com or call REPLACE-PHONE. We will provide your written estimate within three business days.

We recommend keeping a copy of your Good Faith Estimate with your other care records.