Good Faith Estimate for Relationship Counseling

Under the No Surprises Act, relationship counseling clients who do not have insurance or who are not using insurance have the right to receive an estimate of the expected charges for services.

Current Fee Schedule

The following is a detailed list of expected charges for relationship counseling services at New Chapter Relationship Counseling. These rates are valid for 12 months from the date your personalized Good Faith Estimate is issued:

Service Description

• Relationship Counseling - Couple's Intake
  • $300.00 – $375.00
• Relationship Counseling - Individual Intakes (per partner, if conducted)
  • $300.00 – $375.00
• Relationship Counseling - Gottman Connect Results/Treatment Plan
  • $300.00 – $375.00
• Relationship Counseling - 60-Minute Session
  • $300.00
• Relationship Counseling - 61-75-Minute Session
  • $375.00
• Gottman Relationship Counseling - 76-90-Minute Session
  • $525.00
• Late Cancellation (under 48 hours) / No-Show Fee
  • $300.00

Note: The Gottman Connect digital assessment platform fee is covered by the provider and is not billed to the couple.

Estimated Course and Duration of Services

Relationship counseling is highly individualized. The total number of sessions and the duration of your counseling (ranging from several weeks, to months, or longer) will be determined collaboratively based on your relationship goals, progress, and scheduling preferences. Sessions may range from 60 to 90 minutes depending on your needs.

• Initial Assessment Phase (Typically 3 to 4 sessions): Includes the initial joint intake, individual partner intakes (if conducted), and the Gottman results/treatment planning session.
  • Estimated Assessment Cost: $1,200.00 – $1,500.00
• Ongoing Counseling Phase: Charged per session at the rates listed in the Fee Schedule above, depending on the session length selected (60, 75, or 90 minutes).
  • Example: 10 ongoing 60-minute sessions would total $3,000.00.

Terms and Disclosures

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your relationship counseling needs based on information known at the time the estimate was created.

• Unexpected Costs: This estimate does not include any unknown or unexpected costs that may arise during our work together. You could be charged more if session times are extended or additional sessions are requested.

• Right to Dispute: If you are billed for $400 or more over this Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

• Dispute Resolution Process: You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

  • There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

• More Information: For questions, to learn more and get a form to start the process or to obtain more information about your right to a Good Faith Estimate or the dispute process, visit  www.cms.gov/nosurprises or call (800) 368-1019.

Keep a copy of this Good Faith Estimate in a safe place or take a picture of it. You may need it if you are billed a higher amount.