No Surprises Act & Good Faith Estimate Notice

Evergreen Counseling and Wellness
Last updated: 12.1.25

Under the No Surprises Act (NSA), you have the right to receive a Good Faith Estimate explaining the expected costs of psychotherapy services. This law helps ensure transparency in healthcare pricing and allows clients to better understand and plan for the cost of care.

We are committed to providing clear, upfront information about our fees, so there are no surprises along the way.

Your Right to a Good Faith Estimate

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

  • Psychotherapy sessions

  • Couples therapy

  • Intensives or extended sessions

  • Any self-pay services

This estimate is provided before services begin and is based on the information available at the time.

Who Receives a Good Faith Estimate?

You are eligible for a Good Faith Estimate if:

  • You are a self-pay client (meaning you do not use insurance), or

  • You do not plan to submit your claim to insurance, even if you have coverage

Most clients at Evergreen Counseling and Wellness fall into this category since we are a private-pay practice.

What’s Included in Your Estimate

Your Good Faith Estimate will include:

  • The service type and expected frequency

  • The standard fee for each service

  • The estimated total cost over a 12-month period (or another time frame appropriate for your care)

  • Any additional fees if applicable (e.g., late cancellations, court-ordered services — though these are clearly disclosed beforehand)

This estimate is not a contract. Your actual number of sessions may change depending on your unique needs and therapeutic goals.

When You Will Receive Your Estimate

We provide Good Faith Estimates:

  • When you request one at any time

  • Before your initial appointment

  • When your treatment plan changes in a significant way

  • If you schedule new types of services

If you ever want an updated estimate, simply ask — we’ll provide one within the required timeframe.

Dispute Resolution

If you receive a bill that is substantially higher than your Good Faith Estimate, you have the right to dispute the charges. You can start a dispute process with the U.S. Department of Health and Human Services (HHS).

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

To learn more or begin a dispute, visit:
www.cms.gov/nosurprises

Important Notes

  • A Good Faith Estimate does not determine the length or course of therapy.

  • Therapy is individualized, and the number of sessions you choose is always up to you.

  • We will never pressure you to commit to more sessions than you want or need.

Contact Us

If you have questions or would like a Good Faith Estimate at any time, please contact:

Evergreen Counseling and Wellness
Evergreen, Colorado
Email: help@therapyevergreen.com