Good Faith Estimate
Who this applies to
You are entitled to a Good Faith Estimate if you are uninsured, or if you are insured but choose to pay out of pocket without using your insurance benefits.
What a Good Faith Estimate includes
- Expected cost of services, including session fees
- Relevant diagnosis and service codes (CPT and ICD-10)
- Name and contact information of your treating clinician
- Estimated number of sessions over the next 12 months, based on your presenting concerns
The estimate is based on information known at the time it is prepared. Actual costs may vary depending on your treatment course. A Good Faith Estimate is not a contract and does not require you to obtain services.
Current self-pay rates
- Initial intake session: $100–$150
- Individual therapy (50 min): $100–$150 per session
- Couples therapy (50 min): $100–$150 per session
- Clinical fellow sessions: sliding scale, rates discussed at intake
Rates vary by clinician. Your specific rate will be confirmed before your first appointment.
Dispute resolution
If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute the charge. To initiate a dispute, contact us within 120 days of the date of service. You may also use the Patient-Provider Dispute Resolution process established by the Centers for Medicare & Medicaid Services at cms.gov/nosurprises.
Request an estimate
To request a Good Faith Estimate before scheduling, contact us:
- Email: hello@magentatherapy.com
- Phone: (646) 386-8475
We will provide your estimate in writing at least one business day before your scheduled appointment, or within three business days of your request if you are not yet scheduled.