Notice of Right to Receive a Good Faith Estimate

Gayle Weill, LCSW, LLC
https://gayleweilllcsw.com

Effective Date: January 25, 2026

Your Right to a Good Faith Estimate

I want you to know you have the right to receive a “Good Faith Estimate” explaining how much your mental health care will cost.

Under the law (the No Surprises Act), health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services, including psychotherapy and counseling services.

What You Need to Know

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like other tests, prescription drugs, equipment, and hospital fees.

  • I will provide a Good Faith Estimate in writing at least one (1) business day before your medical service or item. You can also ask for a Good Faith Estimate before you schedule an item or service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. I recommend saving a copy or picture of your Good Faith Estimate.

How This Applies to Therapy Services at Gayle Weill, LCSW, LLC

Because the total cost of mental health treatment can be difficult to predict in advance, Good Faith Estimates for therapy services are based on information available at the time of scheduling.

Your Good Faith Estimate will include:

  • The estimated cost per session

  • The estimated number of sessions (if determinable)

  • The estimated total cost of services over a specific period (such as a year of treatment)

Please note: The actual number of sessions you may need, and the total cost of your treatment, may vary depending on your individual needs, progress, and therapeutic goals. If your treatment plan changes, we will provide you with an updated Good Faith Estimate.

For Uninsured or Self-Pay Clients

If you are scheduling services with Gayle Weill, LCSW, LLC and you:

  • Do not have health insurance, or

  • Choose not to use your health insurance for our services

You are entitled to receive a Good Faith Estimate prior to beginning treatment.

How to Request a Good Faith Estimate

You may request a Good Faith Estimate at any time by contacting us through our website at https://gayleweilllcsw.com.

Questions or Disputes

If you have questions or would like more information about your right to a Good Faith Estimate, you can contact me at gayleweill@gmail.com or 211 E 43rd St, 7th Flr #353, New York, NY 10017.

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

For official CMS information, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Contact Us

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

Gayle Weill, LCSW, LLC
Website: https://gayleweilllcsw.com

This notice is provided in compliance with the No Surprises Act, effective January 1, 2022.