Good Faith Estimates & Your Right to Understand the Cost of Therapy

At Nexus Therapy Group, we believe that understanding the financial side of therapy should be clear, respectful, and straightforward.

When you are considering mental health treatment, worrying about an unexpected bill should not be another source of stress. We provide transparent information about our fees and, when required, a written Good Faith Estimate of the expected cost of your care.

What Is a Good Faith Estimate?

A Good Faith Estimate (GFE) is a written estimate showing the reasonably expected charges for health care services before those services are provided.

Under the federal No Surprises Act, which became effective January 1, 2022, individuals who do not have health insurance or who choose not to use their health insurance to pay for care generally have the right to receive a Good Faith Estimate of expected charges when they schedule services sufficiently in advance or request an estimate.

A Good Faith Estimate is intended to help you understand the anticipated cost of treatment before receiving care. It is not a bill and does not require you to begin or continue treatment.

Who Is Entitled to a Good Faith Estimate?

You may be considered an uninsured or self-pay individual for purposes of the No Surprises Act if:

• You do not have health insurance coverage for the services you are seeking; or

• You have health insurance but choose not to have Nexus Therapy Group submit claims to your insurance plan for those services.

If you are using insurance benefits, your actual financial responsibility may depend on your deductible, copayment, coinsurance, plan limitations, authorization requirements, and other provisions of your insurance coverage.

We encourage insured clients to contact their insurance carrier directly when they would like additional information about their specific benefits and cost-sharing responsibilities.

When Will I Receive My Good Faith Estimate?

Under federal Good Faith Estimate requirements:

• If your appointment is scheduled 3 to 9 business days in advance, the estimate generally must be provided within 1 business day after scheduling.

• If your appointment is scheduled 10 or more business days in advance, the estimate generally must be provided within 3 business days after scheduling.

• You may also request a Good Faith Estimate before scheduling treatment. When requested, it generally must be provided within 3 business days.

Appointments scheduled fewer than three business days in advance are generally not subject to the same advance-estimate timing requirement.

Florida Patient Cost Transparency

Florida law also recognizes a patient's right to obtain information about anticipated health care charges.

Under the Florida Patient's Bill of Rights and Responsibilities, Florida Statutes § 381.026, a health care provider or health care facility must, upon request and before providing medical services, furnish a reasonable estimate of charges for those services.

Florida law further provides that an uninsured person should receive, before a planned nonemergency medical service, a reasonable estimate of charges and applicable information concerning available discount or charity policies.

The statute recognizes that an estimate may not always equal the final amount charged because treatment needs can change.

At Nexus Therapy Group, we incorporate these transparency principles into our financial practices by communicating our fees clearly and providing estimates when applicable.

What Will Nexus Therapy Group Include in Your Estimate?

Because psychotherapy is individualized, it is not always possible to know at the beginning of treatment exactly how many sessions a person will need.

When we prepare a Good Faith Estimate, it may include anticipated charges for services such as:

• Initial diagnostic or clinical assessment

• Individual psychotherapy sessions

• Couples or family psychotherapy, when applicable

• Additional clinically appropriate behavioral health services

• An anticipated frequency of treatment

• An estimated period of treatment

• The expected fee for each identified service

Your estimate will be based on the information reasonably available to Nexus Therapy Group at the time it is prepared.

Why Can the Actual Cost of Therapy Be Different From the Estimate?

Mental health treatment develops according to your individual needs.

During therapy, you and your clinician may decide that treatment should occur more or less frequently, that additional sessions are clinically appropriate, or that your treatment goals have changed.

For example, the total anticipated cost of treatment may change if:

• You attend more or fewer sessions than initially anticipated;

• Your recommended session frequency changes;

• Your clinical needs or treatment goals change;

• You begin a different type of therapy service;

• You discontinue treatment earlier than originally anticipated; or

• An additional service is requested or clinically appropriate.

A Good Faith Estimate therefore represents our reasonable expectation of anticipated charges at the time the estimate is prepared. It is not a guarantee of the exact number of sessions you will attend or the final total cost of care.

Your Therapy Is Collaborative

A Good Faith Estimate does not determine how long you must remain in therapy.

Decisions about treatment frequency, duration, goals, and continued care are made collaboratively between you and your therapist based on your needs and clinical progress.

You may discuss the anticipated frequency of sessions and cost of treatment with your therapist or our office at any time.

What If My Bill Is Significantly Higher Than My Good Faith Estimate?

Federal law provides a patient-provider dispute resolution process for certain uninsured or self-pay individuals.

If you receive a bill from a provider that is at least $400 more than the amount listed on that provider's Good Faith Estimate, you may be eligible to dispute the bill through the federal Patient-Provider Dispute Resolution process.

You should keep a copy of your Good Faith Estimate and any bills or statements you receive.

Information about Good Faith Estimates, your rights under the No Surprises Act, and the federal dispute-resolution process is available through the Centers for Medicare & Medicaid Services (CMS).

You may also contact the federal No Surprises Help Desk at 1-800-985-3059.

If You Are Using Health Insurance

A Good Faith Estimate is different from an insurance quote or Explanation of Benefits.

If Nexus Therapy Group is billing your insurance, the amount you ultimately owe may be determined by your insurance company based on your:

• Deductible

• Copayment

• Coinsurance

• Eligibility

• Covered benefits

• Authorization requirements

• Network status

• Plan limitations

Verification of benefits is not a guarantee of payment by your insurance carrier.

We encourage clients to contact their health plan directly if they would like confirmation of their behavioral health benefits and anticipated financial responsibility.

Our Commitment to Clear and Respectful Financial Communication

At Nexus Therapy Group, our goal is to make beginning therapy feel as understandable and comfortable as possible.

We are committed to providing transparent information about our fees, helping clients understand available payment options, and answering reasonable questions about anticipated treatment costs.

If you are uninsured, choosing to self-pay, or would simply like more information about the cost of services before beginning treatment, please contact our office.

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