Good Faith Estimate

Still Water Therapy LLC
1322 Space Park Drive, C185
Houston, Texas 77058

Effective Date of This Notice: August 3, 2026

You have the right to receive a Good Faith Estimate of what your care will cost.

Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

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 medical tests, prescription drugs, equipment, and hospital fees.

  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, 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.

  • Make sure to 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 or call 1-800-985-3059.

What this means at Still Water Therapy

We believe you should never be surprised by the cost of your care. Transparency around fees is part of how we practice, which is why our self-pay rates are published openly on our Services page.

Who receives a Good Faith Estimate

You are entitled to a Good Faith Estimate if you:

  • Do not have health insurance, or

  • Have health insurance but choose not to use it for your care with us (self-pay)

If you are using insurance benefits that we are in network with, the Good Faith Estimate requirement does not apply to you in the same way. Instead, your costs are determined by your plan's copay, coinsurance, and deductible. We are always glad to help you understand what to expect, and we encourage you to verify your benefits with your carrier before your first session.

When you will receive it

You schedule a session at least 3 business days in advance, Within 1 business day of scheduling

You schedule a session at least 10 business days in advance, Within 3 business days of scheduling

You request an estimate without scheduling, Within 3 business days of your request

You will receive your Good Faith Estimate in writing, either on paper or electronically through our client portal or by email, in whichever format you prefer.

What your estimate will include

Because psychotherapy is an ongoing service rather than a one-time procedure, your Good Faith Estimate will reflect the course of care we reasonably expect, including:

  • ‍ Your name and date of birth

  • A description of the services expected, such as an intake evaluation and ongoing individual, couples, or family sessions

  • The applicable service codes and any expected diagnosis codes

  • The expected fee for each session type

  • The anticipated frequency and number of sessions over the estimate period, up to 12 months

  • The total expected charges for that period

  • The name of the clinician expected to provide your care and our practice information

  • A statement that the estimate is not a contract and does not require you to obtain the services listed.

An honest word about estimating therapy

Therapy is not a fixed procedure with a predictable end date. The number of sessions you need depends on your goals, what emerges in the work, and how you're doing over time. Some people come for eight sessions. Some come for two years. Both are normal.

Our estimate reflects our best professional judgment at the time we write it, based on what you've shared with us and our clinical experience. It is a good faith projection, not a prediction or a limit. It does not obligate you to attend the number of sessions listed, and it does not obligate us to stop at that number if you need more.

If your needs change and your expected course of care changes significantly, we will provide you with an updated Good Faith Estimate.

What the estimate does not include

Your Good Faith Estimate covers the services we reasonably expect to provide. It does not include:

  • Unanticipated services that could not have been reasonably foreseen

  • Late cancellation fees ($50) or missed appointment fees ($100), which are described in our practice policies and are not billable to insurance

  • Services provided by other providers you may see outside our practice.

Your right to dispute a bill

If you are an uninsured or self-pay client and you receive a bill from us that is at least $400 more than the total on your Good Faith Estimate, you have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process.

How the process works:

  • You must start the dispute within 120 calendar days of the date on your bill

  • There is a $25 fee to use the process, which may be waived for financial hardship and is refunded if the dispute is decided in your favor

  • An independent third-party reviewer, not us, decides the outcome

  • While the dispute is pending, we are prohibited from moving your bill to collections or charging late fees on the disputed amount

  • We will not retaliate against you in any way for filing a dispute, and your care with us will not be affected

‍‍To start a dispute or ask questions:

You may also always contact us directly first. If you believe your bill is wrong or something doesn’t look right, please call or email us. We would much rather sort it out together than have you carry that worry alone.

Requesting your Good Faith Estimate

You do not need to wait to be offered one. You can request a Good Faith Estimate at any time, before scheduling or after, and we will provide it in writing within 3 business days.

Still Water Therapy, LLC
1322 Space Park Drive, Suite C185
Houston, Texas 77058
Phone: (713) 338-1266
Email: info@stillwatertherapyllc.com

This notice is provided in accordance with the No Surprises Act, effective January 1, 2022. This information is provided for your awareness and is not legal advice.

© 2026 Still Water Therapy, LLC. All rights reserved.‍ ‍