You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
- Save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059. You can also read the official CMS notice.
Requesting an estimate for counseling
Contact the practice for a written estimate before scheduling treatment or when you schedule. Individual sessions are $175 per session; couple sessions are $225 per session. The introductory call is free and lasts 15 minutes. These published rates are not a personalized Good Faith Estimate. Your written estimate should reflect the anticipated services and frequency of your care.
For services scheduled 3–9 business days in advance, the estimate is generally due within 1 business day after scheduling; for services scheduled at least 10 business days in advance, within 3 business days after scheduling. Estimates requested before scheduling are generally due within 3 business days. Short-notice scheduling may not trigger the same advance-estimate requirement.
If a bill differs from the estimate
You may contact the practice to discuss an explanation or correction. Eligible uninsured or self-pay patients may use the federal patient–provider dispute process when a provider’s billed charges are at least $400 above that provider’s estimated charges. Start that process within 120 calendar days of receiving the initial bill. Federal eligibility rules and an administrative fee apply; see the CMS resource for current instructions. An estimate is not a contract and does not require you to receive care.
Insurance and payment
The practice is an out-of-network provider. Clients pay the session fee directly and receive a superbill to submit to their insurer for possible reimbursement. Reimbursement is not guaranteed. Ask your insurer about benefits, deductibles, and any requirements before starting care. Discuss whether you intend to use insurance when requesting an estimate. Cancellation terms and other individual arrangements are addressed separately; this notice does not create new fees or policies.
Telehealth information and consent
All sessions are online by secure video for New York State residents. Before treatment, the practice discusses telehealth and obtains the applicable consent. This webpage and a booking request are not a substitute for that consent.
- Telehealth can improve access but has limitations: connection failures, interruptions, unauthorized access, and reduced ability to respond to an emergency remotely.
- Use a private location, a reliable connection, and a device you control. Discuss who is present or can overhear; do not record sessions without prior agreement and applicable consent.
- Confirm your physical location and appropriate emergency contact arrangements with the counselor. Tell the practice before a session if you will be outside New York; a session may need to be postponed if legally permitted care is not available there.
- Agree before treatment on what to do if video fails and how to access local urgent support. Telehealth is not appropriate for every need or emergency.
- You can raise concerns about telehealth or discuss other care options. Because this practice is online only, alternatives may involve a referral to another provider.
Confidentiality and participation in care
You can ask questions about treatment, goals, risks, benefits, alternatives, and fees; participate in decisions; and decline treatment or discuss ending it. Ask about referrals or continuity of care when needed.
Counseling information is confidential, with exceptions required or permitted by law, such as certain abuse reports, serious threats, or legally valid disclosures. New York law may provide greater protections than HIPAA. Ask how these rules affect your circumstances, particularly in couples counseling. Detailed privacy rights, record-access requests, and authorizations are covered by the Notice of Privacy Practices.
The practice’s website forms are for brief inquiries, not treatment, emergency services, record uploads, or confidential clinical messaging.
Questions, concerns, and complaints
You may raise concerns directly with Salman Hafeez, LMHC, using the contact details below. You may also contact the relevant oversight agency without first speaking to the practice.
- Professional conduct: New York State Education Department, Office of the Professions, Office of Professional Discipline, written complaint instructions and form. Salman Hafeez’s NYS LMHC license number is 016181.
- Health-information privacy: U.S. Department of Health and Human Services, Office for Civil Rights, complaint information, or 1-800-368-1019.
- Good Faith Estimates and eligible billing disputes: CMS No Surprises resources, or 1-800-985-3059.
The practice will not retaliate against you for exercising privacy rights or filing a privacy complaint.