Who has this right
The Good Faith Estimate (GFE) is a protection under the federal No Surprises Act for people who are uninsured or who choose to pay on their own. CMS, which explains these rights on its No Surprises pages, puts it simply: usually, if you are not using health insurance to pay for your care, your provider must give you a good faith estimate of expected charges if you ask for one or schedule services at least three business days in advance.
That covers two groups who often see therapists:
- People without health insurance
- People who have insurance but tell the therapist they will not use it, for example because the therapist is out of network, because they want to keep therapy out of their claims history, or because the deductible is so high that insurance would not pay anyway
If you plan to use insurance, the dispute process described below does not apply to you. Your plan's cost sharing and appeal rules do instead. Using Blue Cross Blue Shield of Michigan for Therapy and How Much Does Therapy Cost in Michigan? cover that side.
When you should receive it
CMS lists these timelines:
- Scheduled 3 to 9 business days ahead: the estimate within 1 business day
- Scheduled 10 or more business days ahead: the estimate within 3 business days
- Asked for before scheduling: the estimate within 3 business days of the request
- Scheduled 0 to 2 business days ahead: no estimate is required
You can choose to receive it on paper or by email. A provider can also go over it with you by phone or in person if you ask.
What it should include
CMS says a good faith estimate should give an itemized list of the expected items and services and the expected charge for each. For therapy, that usually means the type of session, its fee and how many sessions are expected over the period it covers.
One estimate for ongoing therapy
Therapy rarely happens in a single visit. HHS guidance addresses that directly: for recurring services such as periodic counseling, a provider may issue a single estimate instead of a new one for each session. That estimate must clearly state the expected scope, such as the timeframe, how often sessions will happen and the total number expected. It cannot cover more than 12 months. If therapy continues past that, you should receive a new estimate.
An estimate is not a promise about how long therapy will take. Clinicians often cannot know that at the start. It is a statement of what they reasonably expect, based on what they know at the time.
What it might leave out
CMS notes an estimate lists charges for one provider or facility only, and may not include services scheduled separately, services from another provider, or care the provider did not anticipate. If you are also seeing a psychiatrist for medication, that practice would give its own estimate.
A worked example
Suppose, as of November 2026, you plan to see Dr. Lehmann privately at her rate of $220 per clinical hour, about once a week. An estimate for recurring sessions might list the fee per session, the expected frequency and an expected number of sessions over a stated period, with a total. If plans change, for example you move to every other week, a revised estimate can reflect that. Ask the office about the details when you schedule. The fees and insurance page lists current rates and the reduced-fee option.
If your bill is much higher than the estimate
CMS runs a patient-provider dispute resolution process. You can use it if all of these are true:
- You did not have or did not use insurance, and you told the provider before your care
- You received a good faith estimate before your appointment
- One provider charged at least $400 more than its estimate
- Your initial bill is dated within the last 120 calendar days
As of November 2026, filing costs a $25 non-refundable fee. If the decision goes in your favor, CMS says the $25 is subtracted from what you owe. While the dispute is open, the provider cannot send the bill to collections, threaten to, or collect late fees on it. An independent reviewer decides whether the extra charges were reasonable. Your cost will not go up because you filed.
Before filing, it is often worth calling the practice first. Many billing gaps are simple errors, and CMS notes that you and the provider can settle the amount before the dispute ends.
If you did not get an estimate
CMS says you need an estimate to dispute a bill, so ask for one if you have not received it. If you think you should have received one and did not, you can submit a complaint through CMS. Filing a complaint does not cancel the bill, but CMS says it helps make sure you and others receive estimates in the future. The No Surprises Help Desk answers questions at 1-800-985-3059, in English, Spanish and many other languages.
Why this matters for therapy
Money worries can be a reason people delay care for anxiety or depression. Knowing the expected cost in writing makes it easier to plan and to ask about a different pace or a reduced fee when needed. If you are thinking about starting therapy for anxiety, asking for an estimate is a normal part of the first call.