Legally Required Notice · No Surprises Act
Good Faith Estimate
Your Right to a Good Faith Estimate of Expected Charges • Pura Vida Mind & Body PLLC
Who This Applies To
You are entitled to a Good Faith Estimate if:
- You don't have health insurance, or
- You have insurance but are not planning to use it for your care at this practice (self-pay), or
- You are shopping for care and have asked us for a cost estimate.
If you have in-network insurance and choose to use it, your insurer determines your costs (copays, coinsurance, deductibles) based on your plan benefits, and this estimate does not apply to that visit.
Note: if you were referred to this practice through Headway, Alma, Grow Therapy, or a similar third-party insurance-network platform, your costs, billing, and any estimate are managed directly by that platform under its own agreement with your insurer — not by Pura Vida Mind & Body PLLC.
How and When You'll Receive It
If you qualify, we will give you a written Good Faith Estimate:
- Within 1 business day of scheduling, if your appointment is scheduled at least 3 business days out; or
- Within 3 business days of scheduling, if your appointment is scheduled at least 10 business days out; or
- Within 3 business days of your request, if you ask for an estimate before scheduling.
Because mental health and psychiatric treatment length and frequency vary by individual, your estimate describes expected per-visit fees rather than a fixed total for an entire course of care.
Current Self-Pay Fee Schedule
| Service | Standard Rate | Discounted Rate |
|---|---|---|
| Initial Psychiatric Evaluation (75–90 min) | $300 | $255 |
| Initial Therapy Session (75 min) | $225 | $190 |
| ADHD Initial Evaluation & Testing | $325 | $325 |
| Follow-Up: Medication Management with Therapy | $200 | $175 |
| Follow-Up: Medication Management only | $150 | $135 |
| Therapy sessions (60 min) | $175 | $150 |
Standard Rate is our base self-pay fee; Discounted Rate reflects our active promotional discount and is subject to change at any time without notice. ADHD Initial Evaluation & Testing is priced separately at a flat $325 and is not eligible for discounts. See our Pricing & Insurance page for the most current fee schedule.
This is not a bill. A Good Faith Estimate is not a contract and does not require you to obtain any of the listed services. Actual charges may differ from the estimate based on the services you actually receive, and additional services your provider recommends during care may require a separate estimate.
Your Right to Dispute a Bill
If you receive a bill from us that is at least $400 more than your Good Faith Estimate, you have the right to dispute it. Starting a dispute will not affect the quality of the care you receive.
- You must start the dispute process within 120 days (4 months) of the date on the original bill.
- For information about the dispute resolution process, or any other questions about your right to a Good Faith Estimate, contact the No Surprises Help Desk at 1-800-985-3059 or visit cms.gov/nosurprises.