Good Faith Estimate Notice (No Surprises Act)

Your Right to a Good Faith Estimate

Under the law, health care providers are required to give clients who are uninsured or not using insurance an estimate of the expected charges for services.

You have the right to receive a Good Faith Estimate explaining how much your mental health care will cost before you begin treatment.

If you are not enrolled in insurance, or you choose not to use your insurance benefits, you may request a written estimate of the cost of services at least one business day before your scheduled appointment.

The Good Faith Estimate will include:

• The cost of your initial consultation

• The cost of ongoing individual, couples, or group therapy sessions

• Any other reasonably expected charges

Please note:

• The estimate is based on information known at the time it is provided.

• Actual services and frequency may change depending on your needs.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

For questions or to request a Good Faith Estimate, please contact:

Gia Lioi, LCSW
gia@gialioi.com
(646) 386-1322

You can also learn more about your rights at www.cms.gov/nosurprises.

Yes, I am in-network with Aetna, Carelon Behavioral Health, Cigna, Highmark, and Quest Behavioral Health.

$150 for individual therapy

$190 for couples therapy

$100 for group sessions

I do offer a sliding scale