Good Faith Estimate
(No Surprises Act)

Effective Date: January 20, 2026

You have the right to receive a Good Faith Estimate explaining how much your mental health care services are expected to cost.

This notice is provided in accordance with the No Surprises Act, a federal law designed to promote transparency and protect individuals who are uninsured or choosing to self-pay for services.

What Is a Good Faith Estimate?

A Good Faith Estimate is a written explanation of the expected costs for mental health services you may receive. It is meant to help you understand potential fees before services begin, so there are no surprises along the way.

Who Is Eligible?

You are entitled to receive a Good Faith Estimate if you:

  • Do not have insurance, or

  • Are choosing to self-pay and not use insurance benefits

You may request a Good Faith Estimate at any time: before starting services or during ongoing care.

What the Estimate Will Include

Your Good Faith Estimate may include:

  • The cost of individual therapy sessions

  • The anticipated frequency of sessions

  • The duration of services (when reasonably foreseeable)

  • Any other expected services related to your care

Please note: Therapy is individualized and collaborative. Actual services and frequency may change over time based on your needs.

Important Billing Information

A Good Faith Estimate is not a bill

  • The estimate reflects expected costs based on the information available at the time it is provided

  • If circumstances change, you may receive an updated estimate

Your Right to Dispute Charges

If you receive a bill that is $400 or more above your Good Faith Estimate, you have the right to dispute the charges.

You may initiate a dispute through the U.S. Department of Health and Human Services (HHS).

For more information, visit www.cms.gov/nosurprises
or call 1-800-985-3059

How to Request a Good Faith Estimate

To request a Good Faith Estimate, please contact:

The Mental Hug, LLC
Email: brenton@thementalhug.com
Phone: 816-312-5709

Requests can be made before scheduling services or at any point during treatment.

A Note on Transparency & Care

This policy exists to support transparency, informed decision-making, and respect for your autonomy. If you have questions about fees, frequency, or payment options, those conversations are always welcome.

If you have questions about this information, please contact:

Brenton Guice, MA, LPC, RDH
Email: brenton@thementalhug.com