You have the right to receive a Good Faith Estimate explaining how much your healthcare will cost.
If you are uninsured or choose not to use insurance, you have the right to a written estimate of the total expected charges for non-emergency healthcare items and services. You can request an estimate before scheduling care. This notice and fee schedule are general information, not your personalized Good Faith Estimate.
Services & self-pay fees
| Service | Fee |
|---|---|
| Evaluation | $200 |
| Individual therapy · per session | $120 |
Your estimate will reflect your planned services, frequency, and duration of care. The length and frequency of treatment vary by individual; no treatment schedule is required by the examples below.
- 1 evaluation + 12 individual sessions
- $1,640
- 1 evaluation + 24 individual sessions
- $3,080
- 1 evaluation + 48 individual sessions
- $5,960
Illustrative totals include one $200 evaluation plus $120 for each individual therapy session. Actual charges depend on services received. Insurance copays, deductibles, and coinsurance depend on your plan and are not represented by these self-pay examples.
When you receive your estimate
When care is scheduled 3–9 business days in advance, the estimate must generally be provided within 1 business day after scheduling. When scheduled at least 10 business days in advance, it must generally be provided within 3 business days after scheduling. An estimate requested before scheduling must generally be provided within 3 business days of the request. It includes expected costs of the items and services reasonably expected as part of your care.
Your rights & billing disputes
- A Good Faith Estimate is not a contract and does not require you to obtain services from Jus’Therapy PLLC.
- If a provider’s bill is at least $400 above that provider’s estimated charges, you may be eligible for the federal patient-provider dispute resolution process.
- You may contact the practice to ask about the difference, request a correction, or discuss the bill. Contacting the practice does not extend the dispute deadline.
- You must start the federal dispute process within 120 calendar days of the date on the original bill. The process has a $25 administrative fee. The reviewer determines the amount payable under the applicable rules.
- Keep a copy or picture of your Good Faith Estimate and your bill.
For current information and dispute instructions, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Questions or an estimate request
Contact Marisela Milian at the email below to request your personalized estimate or ask about expected charges. Please limit email to administrative matters and do not include sensitive clinical information.