Counseling Fee Estimate

Federal Law — Effective January 1, 2022

Your Rights as a Patient

Good Faith Estimate & The No Surprises Act

Under the No Surprises Act, healthcare providers are required by federal law to give uninsured and self-pay patients a written cost estimate before services begin. Tap any section below to read more.

Does this apply to me?
This applies to you if you are
Uninsured
No health insurance of any kind
Self-Pay
You have insurance but prefer to pay out-of-pocket
Shopping for Care
Comparing costs before you schedule
Numbers to remember
Key numbers at a glance
$400
Dispute threshold
If your bill exceeds your estimate by this amount, you can dispute it
120
Days to dispute
You have 120 days from receiving an unexpected bill to file
12
Months covered
Your estimate covers up to 12 months of therapy sessions
What are my rights?
Your 5 rights — tap each to expand
5 rights to know
1
Right to a Written Estimate
Total expected costs — before any service begins

You have the right to receive a Good Faith Estimate (GFE) — a full written breakdown — for the total expected cost of any non-emergency service. This includes all related costs: tests, fees, equipment, and medications.

For ongoing therapy

Your estimate covers up to 12 months of sessions — including how often you will meet, session length, and total projected cost. After 12 months, your provider must issue an updated estimate.

2
Timing — When You Must Receive It
Clear deadlines your provider must meet

Your provider must deliver the estimate before your appointment — not after. The deadline depends on when you schedule:

Delivery timeframes
Scheduled 3+ days ahead → estimate due within 1 business day
Scheduled 10+ days ahead → estimate due within 3 business days
Requested before scheduling → estimate due within 3 business days of your request
3
Right to Dispute a Higher Bill
If charged $400 or more above your estimate

If your bill comes in $400 or more above your Good Faith Estimate, you have the right to formally dispute it. Disputing will not affect your care.

Dispute resolution process
1
Contact your provider first to resolve it directly.
2
If unresolved, file a dispute with the U.S. Dept. of Health & Human Services (HHS).
3
You have 120 days from receiving the bill to start the dispute.
4
Provide your GFE and bill. An independent arbitrator makes a final ruling.
5
Disputing will not affect the quality of care you receive.
4
Save Your Estimate
Keep a copy — you will need it if anything changes

Save a copy or take a photo of your Good Faith Estimate the moment you receive it. You will need it as documentation if a bill ever comes in higher than expected.

Quick tip

Screenshot it and email it to yourself — that way it is timestamped and backed up automatically.

5
Ask for an Estimate Anytime
No commitment required — it is just information

You can request a Good Faith Estimate at any time — even before you decide to schedule. Asking for an estimate does not commit you to anything.

This Estimate Is Not a Contract

Receiving a Good Faith Estimate does not require you to obtain services from 180 Evolution Therapy or any provider listed in the estimate. Actual charges may differ based on your course of treatment. If anything changes before services begin, we will provide an updated estimate before your next appointment.

Our Commitment to Transparency

At 180 Evolution Therapy, all self-pay and uninsured clients receive a written Good Faith Estimate before services begin — including session frequency, length, rate per session, and total projected cost for up to 12 months. Questions about your estimate or our fees? Contact our office or call (919) 995-8995 — we are happy to walk you through it.

Questions about your rights?
Visit the official CMS resource page for full information.
Visit cms.gov/nosurprises