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No Surprises Act Notice & Good Faith Estimate Disclaimer

Aligned Healing and Wellness Therapy (AHW Therapy)

Aligned Healing and Wellness Therapy is committed to transparency and informed decision-making regarding the cost of your care. In accordance with the No Surprises Act, you have the right to receive a Good Faith Estimate (GFE) that outlines the expected costs of your mental health services.

Your Right to a Good Faith Estimate

If you are not using insurance (self-pay or out-of-network), you are entitled to receive a written Good Faith Estimate before your scheduled appointment. This estimate will include the anticipated fees for therapy sessions and any other professional services provided by AHW Therapy.

Important Information

  • The Good Faith Estimate reflects the expected costs of services based on information available at the time it is created.

  • Actual charges may vary if your treatment plan changes or if additional services are requested or recommended.

  • You are encouraged to keep a copy of your Good Faith Estimate for your records.

  • If you receive a bill that is $400 or more above your Good Faith Estimate, you have the right to dispute the charge through the U.S. Department of Health and Human Services (HHS).

For More Information

To learn more about your rights under the No Surprises Act or how to dispute a bill, visit:
👉 www.cms.gov/nosurprises

If you have questions or would like to request a Good Faith Estimate, please contact:

Aligned Healing and Wellness Therapy (AHW Therapy)
📧 sarah@ahwtherapy.com
📞 319-988-2249

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