Good Faith Estimate

Effective Date: February 1, 2026 | Last Updated: February 1, 2026

1. Your Right to a Good Faith Estimate

Effective January 1, 2022, the No Surprises Act provides protections for patients against unexpected medical bills. Under this law, health care providers are required to give patients who are uninsured or who choose not to use their insurance an estimate of expected charges for scheduled services.

At ZipHealthy, we are committed to transparent pricing and want you to understand your financial responsibility before beginning services.

2. What Is a Good Faith Estimate?

A Good Faith Estimate (GFE) is a written estimate of the total expected cost of any non-emergency healthcare services, including therapy and counseling services. A Good Faith Estimate is not a contract or guarantee of the final cost. Your actual charges may differ based on changes in your treatment plan, unforeseen clinical needs, or services you choose to add or discontinue. The estimate includes:

• A list of expected services and items
• The expected charges for each service or item
• Diagnostic codes and service codes (CPT codes)
• The expected frequency of sessions
• Any other expected fees or costs

3. How It Works

Requesting an Estimate

You can request a Good Faith Estimate at any time, whether you are a new or existing client. Here's what to expect:

• Before Scheduling: You may request a GFE before you schedule any services. We will provide the estimate within 1 business day of your request.
• When Scheduling: When you schedule a service at least 3 business days in advance, we will provide you with a GFE within 1 business day of scheduling.
• Shorter Notice: If you schedule a service less than 3 business days in advance, we will provide the estimate as soon as possible before your appointment.

What the Estimate Includes

Your Good Faith Estimate will include:

• Patient name and date of birth
• Description of the primary service (e.g., individual therapy, couples therapy)
• Expected service code (CPT code)
• Expected diagnosis code (if applicable)
• Expected charges for each service
• Name and National Provider Identifier (NPI) of the provider
• List of services reasonably expected to be provided together

4. What's Included in Your Estimate

For therapy services at ZipHealthy, your Good Faith Estimate typically includes:

• Session Rates: The cost per session for individual, couples, family, or group therapy
• Assessment Fees: Initial intake assessment or diagnostic evaluation costs
• Expected Number of Sessions: A reasonable estimate of how many sessions may be needed based on your treatment goals (this can be adjusted as treatment progresses)
• Additional Services: Any anticipated ancillary services such as letters, reports, or phone consultations

5. Your Rights

You have the right to:

• Receive a Good Faith Estimate for the total expected cost of any non-emergency items or services
• Dispute a bill that exceeds the Good Faith Estimate by $400 or more
• Ask for an updated estimate if your treatment plan changes
• Request itemized bills for any services received
• Keep a copy of your Good Faith Estimate for your records

We recommend you save a copy of every Good Faith Estimate you receive from our office.

6. How to Request a Good Faith Estimate

To request a Good Faith Estimate from ZipHealthy, please contact us:

ZipHealthy PLLC
240 S Main St, Suite #270
Bentonville, AR 72712
Email: [email protected]
Phone: (479) 259-1390

Please provide your name, contact information, and the type of service you are interested in. We will respond with your Good Faith Estimate within 1 business day.

7. Important Note

If you have health insurance and plan to use your benefits, please contact your insurance plan directly to get a cost estimate for therapy services. Your insurance company can provide information about:

• Your deductible and whether it has been met
• Your copay or coinsurance for mental health services
• Any prior authorization requirements
• Whether ZipHealthy providers are in-network with your plan

For questions about insurance coverage, visit our Insurance Verification page or contact our office.