In accordance with the nationally-implemented No Surprises Act, you’re entitled to a Good Faith Estimate that outlines the expected costs of services with us.

Under the law, health care providers and mental health professionals need to give clients who don’t have insurance or who are not using insurance an estimate of the cost for medical and mental health services. Queer AF Therapy does not take insurance. This Act requires medical/mental health professionals to provide a Good Faith Estimate so that clients won’t be surprised by any additional costs to services.

You will receive a Good Faith Estimate (GFE) via email at least one business day prior to your first session with us.

The Good Faith Estimates you receive from Queer AF Therapy are a notice of the maximum price we would charge for our services at our full fee for 10 sessions. This does not represent any sliding scale fees Queer AF Therapy and the client has agreed upon, but the maximum fee we have set for certain types of sessions and administrative work. This notice does not limit the number of sessions we may have together. This notice is not a bill. You may ask for an personalized GFE specific to the amount we have agreed upon at any time.

The GFE does not include any unknown or unexpected costs that may arise during our therapeutic relationship. You could be charged other agreed-upon fees if we are providing more than counseling services. You could be charged more if complications or special circumstances occur. If you are charged more than $400 than your GFE states, federal law allows you to dispute (appeal) the bill with the U.S. Department of Health and Human Services (HHS).

To learn more and get a form to start the process, go to www.cms.gov/nosurprises/consumers or call 1-800-985- 3059. For questions or more information about your right to a GFE or the dispute process, visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059.