Good Faith Estimate
Your right to know the expected cost of therapy services under the No Surprises Act
Good Faith Estimate
Mary DiOrio, LCSW, LLC
Your Right to a Good Faith Estimate
Under the No Surprises Act (effective January 1, 2022), health care providers are required to give patients who don't have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider for a Good Faith Estimate before you schedule a service, or at any time during your care.
Current Session Rates
The following rates are effective as of January 2026. These rates apply to self-pay clients and those choosing not to use insurance benefits.
Initial Intake Session
50 minutesComprehensive first session including assessment and treatment planning
Individual Therapy
50 minutesOne-on-one psychotherapy session
Couples Therapy
50 minutesStandard couples/relationship therapy session
Extended Couples Session
90 minutesIn-depth couples work for complex issues
Payment is due at the time of service. We accept all major credit cards and HSA/FSA cards via our secure client portal.
Estimating Your Treatment
“It is not possible to predict in advance the exact number of sessions you may need or choose to attend.”
The duration of therapy varies significantly from person to person and depends on many factors, including:
- The nature and complexity of your concerns
- Your personal goals for therapy
- How you respond to treatment
- Life circumstances that may arise during treatment
- The frequency of sessions (weekly, biweekly, etc.)
Some clients find relief in a few months of weekly sessions, while others benefit from longer-term work spanning a year or more. We will discuss treatment duration and goals during our initial sessions and revisit them periodically throughout our work together.
Sample Cost Estimates
To help you plan, here are sample estimates based on common treatment frequencies. These are estimates only and actual costs will depend on your individual treatment plan.
| Scenario | Monthly Est. | 3-Month Est. |
|---|---|---|
| Weekly Individual Sessions | $760 | $2,280 |
| Biweekly Individual Sessions | $380 | $1,140 |
| Weekly Couples Sessions | $800 | $2,400 |
| Biweekly Extended Couples | $550 | $1,650 |
*Estimates assume 4 weeks per month. First month includes initial intake fee ($220) in place of one regular session.
Your Right to Dispute
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You have the right to initiate the patient-provider dispute resolution process.
Important:
- • Save a copy or picture of your Good Faith Estimate for your records
- • You may request a new estimate at any time during your treatment
- • Make sure your provider knows if your insurance status changes
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Contact Information
If you have questions about this Good Faith Estimate or would like to request an estimate for your expected treatment, please contact:
Mary DiOrio, LCSW, LLC
Phone
(503) 555-0100Good Faith Estimates are provided within 1 business day of scheduling an appointment, or within 3 business days upon request.