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• Under the law, health care providers are required to give clients who do not have insurance or who are not using insurance an estimate of the expected charges for medical and mental health services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including psychotherapy services.

• At Pink Again Maternal Wellness, current self-pay fees are as follows:

• Individual Therapy (53 minutes): $130 per session

• Couples Therapy (53 minutes): $130 per session

• Family Therapy (53 minutes): $130 per session

• The Good Faith Estimate outlines the expected costs of services based on the information known at the time it is provided. Actual services or frequency of sessions may vary depending on your individual needs and treatment plan.

• You may request a Good Faith Estimate before scheduling services or at any time during treatment.

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

• For questions or to request your Good Faith Estimate, please contact:

• Pink Again Maternal Wellness
  fallon@pinkagainmaternalwellness.com
  201-743-9796