Effective Date: September 6, 2026
Last Updated: September 6, 2026
Your Right to Receive an Estimate of the Expected Cost of Your Care
Under the federal No Surprises Act, individuals who do not have health insurance or who are not using health insurance to pay for their care generally have the right to receive a “Good Faith Estimate” explaining how much their health care is expected to cost.
This page explains your Good Faith Estimate rights and provides general information about self-pay psychotherapy services at AZ MHC LLC d/b/a Anxiety Arizona (“Anxiety Arizona”).
This webpage is not your individualized Good Faith Estimate. When required, Anxiety Arizona will provide you with a Good Faith Estimate based on the services that are reasonably expected to be provided to you.
You generally have the right to receive a Good Faith Estimate if you:
These individuals are generally referred to as “uninsured” or “self-pay” individuals under the federal Good Faith Estimate requirements.
If you intend to use health insurance to pay for your services, different cost-sharing and insurance requirements may apply. Your health plan is generally the best source of information regarding your deductible, copayment, coinsurance, coverage, network status, and other plan-specific financial responsibility.
You have the right to receive a Good Faith Estimate of the expected charges for scheduled health care services when the federal requirements apply.
Under current federal requirements:
If a service is scheduled fewer than 3 business days in advance, the federal requirement to provide a Good Faith Estimate based on scheduling generally does not apply. You may still ask Anxiety Arizona about the expected cost of your care.
You do not have to schedule psychotherapy before asking about its expected cost.
If you are uninsured or intend to pay for care without using insurance, you may request a Good Faith Estimate from Anxiety Arizona before scheduling services.
You do not need to use the specific words “Good Faith Estimate” when asking for information about the expected cost of care.
Anxiety Arizona’s current standard self-pay fee for individual psychotherapy with a licensed psychologist is:
$185 per 55-minute psychotherapy session.
Your individualized Good Faith Estimate will be based on the services that are reasonably expected at the time the estimate is prepared.
If a different service, session length, fee, or arrangement applies to you, your individualized Good Faith Estimate should reflect the expected charges applicable to your care rather than relying solely on the standard fee listed on this webpage.
Psychotherapy differs from many health care services because the appropriate duration and frequency of treatment may not be known at the beginning of care.
The frequency and duration of psychotherapy depend on factors such as your clinical needs, treatment goals, progress, preferences, the treatment approach being used, and whether continued treatment remains clinically appropriate.
Accordingly, a Good Faith Estimate for psychotherapy is an estimate of services reasonably expected at the time it is prepared. It is not a recommendation or requirement that you attend a particular number of sessions.
At the current standard self-pay rate of $185 per 55-minute psychotherapy session, examples of potential costs are:
These examples are provided for general informational purposes only and are not an individualized Good Faith Estimate or a prediction of how many psychotherapy sessions you will need.
Your actual treatment may involve fewer or more sessions, a different frequency, or other clinically appropriate changes.
Federal rules permit a provider to issue a single Good Faith Estimate for recurring services, including recurring counseling or psychotherapy services, when the expected scope of those services is described clearly.
A Good Faith Estimate for recurring services may identify the anticipated frequency, timeframe, and number of services expected to be provided.
A single Good Faith Estimate for recurring services may cover a period of up to 12 months. If recurring services are expected to continue beyond the period covered by the estimate, a new Good Faith Estimate may be provided as required by applicable law.
A Good Faith Estimate does not obligate you to receive any particular service from Anxiety Arizona and does not require you to complete a predetermined number of psychotherapy sessions.
It also does not guarantee that treatment will continue for the entire period reflected in an estimate.
You and your psychologist may periodically evaluate your treatment plan, progress, clinical needs, treatment frequency, and whether continued psychotherapy is appropriate.
You may generally choose to discontinue services, subject to applicable clinical, financial, scheduling, and practice policies.
A Good Faith Estimate is based on information reasonably known when the estimate is prepared. It is not possible to anticipate every change that may occur during psychological treatment.
The expected cost of your care may change if, for example:
When a change to the anticipated scope of services requires a new Good Faith Estimate under applicable federal requirements, Anxiety Arizona will provide an updated estimate within the applicable timeframe.
A Good Faith Estimate is intended for individuals who are uninsured or who are choosing not to use insurance or other applicable coverage to pay for their care.
If you choose to use insurance, the amount you ultimately owe may depend on your health plan and may differ from Anxiety Arizona’s standard self-pay rate.
Insurance benefits are determined by your health plan. Information obtained about benefits or eligibility is not a guarantee that your insurer will pay a claim or that a particular service will be covered.
You remain responsible for understanding your insurance benefits and for amounts assigned to you by your health plan, subject to applicable law and your financial agreement with Anxiety Arizona.
Please keep a copy of any individualized Good Faith Estimate you receive.
You may wish to compare the estimate with bills you later receive for the services covered by the estimate.
A copy of your Good Faith Estimate may also be necessary if you later wish to use the federal Patient-Provider Dispute Resolution process.
If you receive a bill from a provider that is at least $400 more than the expected charges listed for that provider on your Good Faith Estimate, you may be eligible to dispute the bill through the federal Patient-Provider Dispute Resolution process.
An independent third party reviews eligible disputes and determines the appropriate amount to be paid.
Federal eligibility requirements and deadlines apply. Under current federal guidance, an eligible dispute generally must be initiated within 120 calendar days of the date on the initial bill.
Starting a dispute does not prevent you and the provider from attempting to resolve the billing issue directly.
For information about Good Faith Estimates, your medical billing rights, or the federal Patient-Provider Dispute Resolution process, visit the Centers for Medicare & Medicaid Services (CMS) medical billing rights website:
You may also contact the federal No Surprises Help Desk:
No Surprises Help Desk
Phone: 1-800-985-3059
Additional information about disputing a medical bill is available from CMS:
If you have questions about the expected cost of your services, your self-pay fee, or a Good Faith Estimate you received from Anxiety Arizona, please contact us.
If you are uninsured or do not intend to use insurance to pay for your services, you may also request an individualized Good Faith Estimate.
AZ MHC LLC d/b/a Anxiety Arizona
560 W Brown Road, Suite 3001 / PMB 17544975
Mesa, AZ 85201
United States
Email: therapy@anxietyarizona.com
Phone: 480-418-3919
Website: AnxietyArizona.com
Clinical Director: Daniella Pedroso, Psy.D.
A Good Faith Estimate is an estimate of the charges reasonably expected for your care based on information known when the estimate is prepared. It is not a bill, a treatment contract, a guarantee regarding the length or outcome of treatment, or a requirement that you receive the services listed in the estimate.
You have the right to receive a Good Faith Estimate when required by applicable law and to ask questions about the expected cost of your care.
