Good Faith Estimate & Your Right to a No Surprises Act Notice
Effective Date: September 29, 2026
Under the federal No Surprises Act, you have the right to receive a Good Faith Estimate explaining how much your mental health care will cost.
Your Right to a Good Faith Estimate
If you do not have insurance, or you choose not to use insurance to pay for your care, health care providers — including kapilu Art Therapy — are required to give you an estimate of the expected cost of treatment before you receive services.
You have the right to receive a Good Faith Estimate for:
The total expected cost of any counseling services
A description of the services and their billing codes
The frequency and estimated duration of care, when known
When You'll Receive It
You can request a Good Faith Estimate at any time, including before scheduling services. If you are a new or existing self-pay client, we will provide a written estimate:
Within 1 business day of scheduling, if your service is scheduled at least 3 business days out
Within 3 business days of scheduling, if your service is scheduled at least 10 business days out
Upon request, at any time, even before scheduling
What's Included
Your Good Faith Estimate will include:
The expected charges for each service (based on our current session rates, listed on our Services & Rates page)
The relevant billing codes for each service
The name and credentials of the provider furnishing care
A general timeframe for the scope of care, since ongoing therapy is difficult to predict exactly
Because therapy is individualized and the number of sessions needed can change based on your progress and needs, this is an estimate, not a contract or a guarantee of final cost.
Your Right to Dispute a Bill
If your actual bill is $400 or more above your Good Faith Estimate, you have the right to dispute the charge. You may start this process by contacting the U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-985-3059, or visiting cms.gov/nosurprises.
Who This Applies To
This right applies to you if:
You do not have health insurance, or
You have insurance but choose not to use it for your care with kapilu Art Therapy
Once insurance billing through Headway is active, this notice continues to apply to any client who chooses to pay privately rather than bill insurance.
Questions or Requests
To request your Good Faith Estimate, or with any questions about this notice, contact:
Kami Land, LPC, PLLC dba kapilu Art Therapy kami@kapiluarttherapy.com (512) 228-7278
For more information about your rights under the No Surprises Act, visit cms.gov/nosurprises or call 1-800-985-3059.