Your Right to a Good Faith Estimate
The text below incorporates the standard "Right to a Good Faith Estimate" notice required by 45 CFR §149.610 and current CMS guidance. The required disclosure language is preserved verbatim where federal regulation specifies it.
You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
How Pasadena Clinical Group provides Good Faith Estimates
If you do not have health insurance, or if you elect not to use your health insurance to pay for our services, we will provide you with a Good Faith Estimate (GFE) of the expected charges for your care:
- Before your first scheduled session, we will provide a written GFE that lists the services we anticipate, the expected cost per session, and the expected frequency and duration of treatment based on the information available at that time.
- If treatment is expected to last more than 12 months, our GFE will cover up to 12 months of expected care; we will provide an updated GFE before continuing into a subsequent period.
- If your needs change in a way that materially affects the estimate (for example, a step-up in level of care to IOP), we will provide an updated GFE.
- You may request a GFE at any time before scheduling, by phone or email.
Patient–Provider Dispute Resolution Process
If you receive a bill that is at least $400 more than the total expected charges in your Good Faith Estimate, you may initiate a Patient–Provider Dispute Resolution Process administered by the U.S. Department of Health and Human Services. The dispute must be initiated within 120 days of receiving the bill that is in dispute. There is a $25 administrative fee that is generally non-refundable; if the dispute is decided in your favor, the disputed bill will be reduced.
You can begin the process at www.cms.gov/nosurprises or by calling 1-800-985-3059.
Selecting your provider
The federal No Surprises Act gives you the right to choose a different provider if you wish. To explore other providers, you can use the our insurance information page, contact your insurance carrier directly, or use Psychology Today's directory or your insurer's online provider search.
Anticipated charge ranges (illustrative — to be confirmed by practice billing manager)
The ranges below are placeholders pending confirmation by Pasadena Clinical Group's billing manager. Actual GFEs will reflect verified, current rates.
- Initial assessment / intake (60–75 min): $TBD–$TBD
- Individual psychotherapy session (50 min): $TBD–$TBD
- Couples or family therapy session (60–80 min): $TBD–$TBD
- Group therapy session (75–90 min): $TBD–$TBD
- Intensive Outpatient Program (per week): $TBD–$TBD
Contact for billing questions
Pasadena Clinical Group · Billing · 301 N. Lake Ave, STE 600, Pasadena, CA 91101 · (626) 354-6440 · office@pasadenaclinicalgroup.com