Good Faith Estimate

Last updated November 2025

Your Rights and Protections Against Surprise Billing

At Willow and Ivy Counseling, PLLC, transparency in fees and billing is an essential part of providing ethical and supportive care. As required by the No Surprises Act (2022), clients who choose to self-pay for services—or who are uninsured—have the legal right to receive a Good Faith Estimate (GFE) of expected charges for mental health services. This estimate helps you understand potential costs before treatment begins.

Your Right to a Good Faith Estimate

Under federal law, you are entitled to:

1. Request a Good Faith Estimate at Any Time

You can request an estimate of expected service costs before scheduling, during the intake process, or at any point throughout treatment. The estimate will outline the anticipated number of sessions, session length, and associated fees based on your treatment plan.

2. Receive Your Estimate in Writing

Your Good Faith Estimate will be provided in written form and kept in your client record. You may also request an additional copy at any time.

3. Dispute a Bill That Is Significantly Higher

If you receive a bill that is $400 or more above the amount listed in your Good Faith Estimate, you have the right to dispute the charge through the patient-provider dispute resolution process.

What Is Included in a Good Faith Estimate

Your estimate may include:

  • Individual therapy session fees

  • Diagnostic assessment fees (if applicable)

  • Late cancellations or no-show fees, when relevant

  • Any optional, client-requested services

  • Estimated duration of treatment, if this can be reasonably projected

Please note: Therapy is individualized, and treatment needs may change over time. Your Good Faith Estimate is not a contract for a specific number of sessions—it is an estimate to support informed decision-making.

What Is Not Covered by a Good Faith Estimate

The Good Faith Estimate does not apply to:

  • Clients using in-network insurance benefits

  • Services billed to insurance providers

  • Emergency services

  • Services scheduled less than three business days in advance

How to Request a Good Faith Estimate

To receive a Good Faith Estimate, please contact:

Willow and Ivy Counseling, PLLC
Elizabeth Tyrpak, LCPC
Email: lizzi@willowandivycounseling.com
Phone: 773.985.4735
Office Location: Telehealth Only (Illinois)

You may request an estimate before scheduling a session, or at any point during the course of your care.

If You Believe Your Bill Is Incorrect

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute the charge. You can start the dispute resolution process by visiting the official CMS website and following their instructions: https://www.cms.gov/nosurprises

Additional Information

For more information about your rights under the No Surprises Act, visit the official resources provided by the U.S. Department of Health & Human Services at: https://www.cms.gov/nosurprises