Good Faith Estimate

Your Right to a Good Faith Estimate

Restorative Care Counseling LLC Effective Date: August 11, 2026

You have the right to receive a Good Faith Estimate

Under the federal No Surprises Act, you have the right to receive a Good Faith Estimate explaining how much your mental health care will cost.

Health care providers are required to give patients who do not have insurance, or who are not using insurance, an estimate of the expected charges for medical and mental health services.

What this means for you

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

  • We will provide one automatically when you schedule, in writing. You do not have to ask.

  • You can also request one at any time before scheduling, and we will provide it within three business days.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through the federal patient-provider dispute resolution process.

  • Keep a copy of your Good Faith Estimate in a safe place.

Timing

When you schedule

  • At least 10 business days before the appointment

  • 3 to 9 business days before the appointment

  • On request, before scheduling

When you receive your estimate

  • Within 3 business days

  • Within 1 business day

  • Within 3 business days

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-985-3059.

Our fee schedule

The rates below reflect our standard private-pay charges. Your individual Good Faith Estimate will be based on the services your clinician expects you to receive.

Licensed Clinicians

Service

  • Free consultation (15 minutes)

  • Initial intake session (60 minutes)

  • Standard therapy session (approx. 55 minutes)

  • Individual therapy, shorter session (45 minutes)

  • Couples or family therapy (50 minutes)

Rate

  • No charge

  • $150

  • $125

  • $100

  • $125

Registered Mental Health Counselor Interns

Services may be provided by registered interns practicing under the supervision of a licensed clinician, in accordance with Florida law. Intern rates are lower.

Service

  • Initial intake session (60 minutes)

  • Standard therapy session (approx. 55 minutes)

  • Individual therapy, shorter session (45 minutes)

  • Couples or family therapy (50 minutes)

Rate

  • $125

  • $100

  • $75

  • $100

Additional fees

Service

  • Late cancellation (same calendar day as appointment)

  • No-show

  • Returned or declined payment

Rate

  • $50

  • $100

  • $10

Fees for additional services — such as records requests, letters, reports, or documentation for employers or disability claims — are discussed and agreed upon in advance.

If you are using insurance

We are in-network with select insurance plans. If you are using insurance, the Good Faith Estimate requirement does not apply to you, and your actual cost depends on your specific plan.

Important: Verification of benefits is a quote from your insurance company, not a guarantee of payment. You remain responsible for copays, coinsurance, deductibles, and any amount your plan does not cover.

We verify your benefits before your first appointment and tell you what we expect your cost to be. That estimate is confirmed once your first claim is processed.

Late cancellation and no-show fees are not billable to insurance and are your responsibility.

If we are not in-network with your plan

You may be seen as a private-pay client at the rates above. On request, we will provide a superbill you can submit to your insurance company for possible out-of-network reimbursement. Reimbursement is not guaranteed, and we do not bill out-of-network plans directly.

Sliding scale

We offer a limited sliding scale for private-pay clients experiencing financial hardship. Eligibility is determined by application, based on household income, household size, and financial circumstances. Rates are reassessed every four to six months and depend on availability.

Ask us if you would like to apply.

Disclaimer

This information reflects estimated costs based on services reasonably expected at the time of issuance. It is not a binding contract. Actual charges may vary depending on session frequency, duration, clinician type, treatment needs, or changes in services.

Questions

Restorative Care Counseling LLC

Phone: (786) 849-9976

Email: [email protected]

Address: 1032 E Brandon Blvd #1997, Brandon, FL 33511-5509

If you are in crisis, this is not an emergency service. Call or text 988, or dial 911.

Providing Mental Health Care Throughout Florida

Providing Mental Health Care Throughout Florida

If you're in crisis, this is not an emergency service. Call or text 988

If you're in crisis, this is not an emergency service. Call or text 988