Good Faith Estimate | Natural State Women's Wellness

Leighton accepts insurance. If you're using your insurance, what you pay depends on your plan. See Insurance for how to check your benefits.

A Good Faith Estimate is for people who are uninsured or who choose not to use their insurance for therapy. If that's you, you have the right to know what therapy is expected to cost before you begin. Leighton will give you a written Good Faith Estimate when you schedule, and you can ask for one anytime.

At Natural State Women's Wellness:

A [LENGTH]-minute individual session is [SELF-PAY FEE].
[COUPLES/FAMILY SESSION: LENGTH + SELF-PAY FEE — if offered]
[INITIAL ASSESSMENT/INTAKE: LENGTH + SELF-PAY INTAKE FEE — if different]
Your estimate will list the expected number of sessions [e.g. "based on a typical starting plan of [N] sessions"]. Therapy is often ongoing and can't always be predicted, so you'll get an updated estimate if your plan changes. (Note: Note for Leighton: CMS FAQs allow recurring services to be covered in one GFE for up to 12 months. Confirm your process.)

Please keep a copy of your estimate. You'll need it if you ever want to compare it with a bill or dispute one.

Questions about cost? [CONTACT METHOD].

You have the right to receive a "Good Faith Estimate" explaining how much your health care will cost

Under the law, health care providers need to give patients who don't have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.