Good Faith Estimate Notice

Effective Date: 10/2/2025
Last Updated:10/2/2025

Under the No Surprises Act (Section 2799B-6 of the Public Health Service Act), you have the right to receive a Good Faith Estimate (GFE) explaining the expected cost of your mental health services when you are not using insurance and are paying out-of-pocket (self-pay).

Your Right to a Good Faith Estimate

You have the right to:

  • Receive a written Good Faith Estimate for the total expected cost of services when scheduling therapy, upon request, or before your first appointment.

  • Request an updated estimate at any time if your treatment plan, session frequency, or fees change.

  • Receive clear information about fees before you commit to services.

What Is a Good Faith Estimate?

A Good Faith Estimate outlines the anticipated charges for services you may receive.
This includes:

  • Session fees (e.g., individual, couples, or family therapy)

  • Any additional services discussed and agreed upon during treatment

The estimate reflects the best available projection of costs based on your initial plan of care.
Your actual charges may vary if:

  • The frequency or length of sessions changes

  • You request additional services or resources

  • Your treatment goals or needs evolve over time

You will be notified of any significant changes to your estimated costs before they take effect.

Dispute Resolution

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

  1. Contact your therapist first to review and discuss the bill.

  2. If you still disagree with the charges, you can initiate a formal dispute with the U.S. Department of Health and Human Services (HHS).

    • Visit https://www.cms.gov/nosurprises

    • Or call 1-800-985-3059 for more information.

You must start the dispute process within 120 calendar days of receiving the bill.

Please Note

  • The Good Faith Estimate is not a contract and does not obligate you to receive services.

  • It is simply an estimate to help you anticipate potential costs and plan your care accordingly.

  • No services will be billed to insurance; all payments are due directly to the practice.

Contact Information

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

Andrea Morinoue Therapy
Andrea Morinoue, LMFT
Carlsbad, CA
Email: andrea@andreamorinouetherapy.com