Story Arc Therapy and Wellness, LLC
Effective Date: July 30th, 2026
Last Updated: August 25th, 2026
Your Right to a Good Faith Estimate
Under the federal No Surprises Act, individuals who are uninsured or who choose not to use their health insurance for healthcare services generally have the right to receive a Good Faith Estimate (GFE) of expected charges before receiving care.
Story Arc Therapy and Wellness, LLC (“Story Arc Therapy and Wellness,” “we,” “us,” or “our”) is committed to providing prospective and current clients with clear information about the expected cost of services.
A Good Faith Estimate is an estimate of the expected charges for healthcare items and services that we reasonably expect to provide.
A Good Faith Estimate is not a bill, does not constitute a guarantee of the final cost of care, and does not establish a diagnosis, treatment plan, or therapeutic relationship.
Who Is Eligible for a Good Faith Estimate?
Good Faith Estimate requirements generally apply to individuals who:
- Do not have health insurance; or
- Have health insurance but choose not to use their insurance to pay for the services.
If you intend to submit claims to your health insurance plan for services provided by Story Arc Therapy and Wellness, the Good Faith Estimate requirements applicable to uninsured or self-pay individuals may not apply in the same manner.
If you are unsure whether you are considered uninsured or self-pay, please ask us before beginning services.
When You Will Receive a Good Faith Estimate
You may request a Good Faith Estimate before scheduling services.
If you request an estimate, Story Arc Therapy and Wellness will provide the estimate within the timeframe required by applicable law.
Generally:
- If you schedule services at least 10 business days in advance, the estimate will generally be provided no later than 3 business days after scheduling.
- If you schedule services at least 3 business days but fewer than 10 business days in advance, the estimate will generally be provided no later than 1 business day after scheduling.
- If you request an estimate before scheduling services, the estimate will generally be provided no later than 3 business days after your request.
- Services scheduled fewer than 3 business days in advance generally are not subject to the federal GFE requirement, although Story Arc Therapy and Wellness may provide an estimate voluntarily when practical.
These timeframes are based on current federal requirements and may change if applicable law or regulations are amended.
What Your Good Faith Estimate Includes
Your Good Faith Estimate will generally include an itemized description of the healthcare services that Story Arc Therapy and Wellness reasonably expects to provide and the expected charge for each service.
For psychotherapy services, an estimate may include items such as:
- Initial diagnostic/evaluation session;
- Individual psychotherapy sessions;
- Family or couples psychotherapy sessions, if offered;
- Other behavioral-health services that we reasonably anticipate providing; and
- Other applicable charges that we reasonably expect to occur.
The estimate may identify applicable service or billing codes where required.
Because psychotherapy is an ongoing process and the number and frequency of sessions may depend on clinical needs and decisions made during treatment, the total duration and cost of treatment may not be known in advance.
Accordingly, an estimate may be based on an anticipated frequency or duration of services rather than a guarantee of the total amount that will ultimately be spent.
Changes to Your Good Faith Estimate
Your expected costs may change if:
- You request additional or different services;
- Your treatment schedule or frequency changes;
- Services are provided that were not reasonably anticipated when the original estimate was prepared;
- You change from insurance billing to self-pay;
- Your clinical needs change; or
- Applicable fees or other circumstances change.
When required by law, we will provide an updated Good Faith Estimate.
You may request an updated estimate at any time.
Your Right to Receive the Estimate in Writing
Good Faith Estimates may be provided electronically or in paper form, consistent with applicable law and your preferences.
When appropriate, Story Arc Therapy and Wellness may provide your estimate through our secure client portal or another electronic method.
We recommend that you retain a copy of your Good Faith Estimate for your records.
If Your Bill Is Substantially Higher Than Your Estimate
The Good Faith Estimate is an estimate of expected charges and is not a guarantee of the final amount owed.
Under federal law, however, if you are uninsured or are not using insurance to pay for your care and your final bill from Story Arc Therapy and Wellness is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process, provided that the applicable legal requirements are met.
You generally must have received a qualifying Good Faith Estimate before receiving the services and must meet other federal requirements to use this process.
Information about the federal dispute process is available through the Centers for Medicare & Medicaid Services (CMS).
You may also contact Story Arc Therapy and Wellness directly if you believe your bill does not accurately reflect the services provided or the applicable estimate.
Important Information About the Estimate
A Good Faith Estimate:
- Is based on information reasonably available when it is prepared;
- Is not a bill;
- Is not a guarantee of the amount you will ultimately owe;
- Does not include services provided by other healthcare providers unless specifically identified;
- Does not necessarily include services that were not reasonably anticipated at the time the estimate was prepared; and
- Does not replace your financial responsibility agreement, consent for treatment, or other practice policies.
If another provider participates in your care, you may need to obtain a separate Good Faith Estimate from that provider.
How to Request a Good Faith Estimate
To request a Good Faith Estimate, contact:
Story Arc Therapy and Wellness, LLC
[email protected]
512-942-7350
storyarctw.com
You may request an estimate before scheduling services.
Please include enough information for us to identify the services for which you are requesting an estimate.
Questions About Your Charges
If you have questions about your expected or actual charges, please contact us before making assumptions about the amount owed.
We are happy to discuss the information contained in your Good Faith Estimate and explain our current fees and billing practices.
Federal Resources
Additional information about Good Faith Estimates and the No Surprises Act is available from the Centers for Medicare & Medicaid Services (CMS).
For information about your rights or the federal Patient-Provider Dispute Resolution process, visit the CMS website or contact the federal No Surprises Help Desk at 1-800-985-3059.