Good Faith Estimate

1. What Is a Good Faith Estimate?

A Good Faith Estimate (GFE) is a written statement that tells you the expected cost of your healthcare services before you receive them. It is not a final bill — it is a reasonable estimate based on your planned treatment.

The right to a Good Faith Estimate was established by the No Surprises Act, enacted as part of the Consolidated Appropriations Act of 2021 and implemented by the Centers for Medicare & Medicaid Services (CMS) effective January 1, 2022. The relevant regulations appear at 45 C.F.R. § 149.610 and 42 U.S.C. § 300gg-136.

The purpose of the law is simple: you should never be surprised by a medical or mental health bill you didn't know was coming. You have the right to understand the cost of care before you commit to it.

2. Who Is Entitled to One

You are entitled to a Good Faith Estimate if you are:

• Uninsured — you do not have health insurance coverage of any kind, or
• Self-pay — you have insurance but are choosing not to use it for these services (for example, you prefer not to have mental health treatment appear on your insurance record, or your out-of-pocket cost is the same either way)

If you are using insurance and we are an in-network provider with your plan, your expected costs are governed by your insurance benefits (copays, deductibles, coinsurance). You are still entitled to ask us for an estimate of what your out-of-pocket costs are likely to be.

If you are using insurance and we are an out-of-network provider, additional protections under the No Surprises Act may apply. Contact your insurance plan for details.

3. Our Session Rates

The following are the standard rates for services at Now & Zen Wellness. These rates apply to self-pay clients and form the basis of any Good Faith Estimate we provide.

4. What the Estimate Includes

A Good Faith Estimate from Now & Zen Wellness will include:

• The expected number of sessions per week or month, based on your presenting concerns and treatment goals
• The expected cost per session based on the service type
• An estimated total cost for a defined period of treatment (typically 90 days or 6 months)
• The diagnosis codes (ICD-10) and service codes (CPT) associated with your planned treatment
• The name and contact information of the provider
• The date the estimate was created

Typical Treatment Ranges

To give you a realistic picture, here are general ranges by presenting concern. These are estimates only:

• Anxiety or depression — 8 to 20 weekly sessions for most people with mild to moderate symptoms
• Single-incident trauma (EMDR) — 6 to 12 sessions for straightforward trauma with a clear origin
• Complex or developmental trauma — 20 to 50+ sessions depending on history, severity, and goals
• Addiction and recovery — highly variable; ongoing weekly support is common in early recovery
• Couples therapy — 12 to 24 sessions is typical; more for significant ruptures like infidelity

We will review your estimate together and update it if your treatment needs change significantly.

5. Insurance vs. Self-Pay

If You Are Using Insurance

Now & Zen Wellness is in-network with the following insurance plans:

• Aetna
• AllSavers
• Blue Cross Blue Shield (BCBS)
• Centivo
• Cigna / Evernorth
• Florida Blue
• GEHA
• Johns Hopkins Health Plans
• Optum
• Oscar
• Oxford
• UHC / United Healthcare
• UMR

If you are using one of these plans, your out-of-pocket cost per session is determined by your plan's copay, deductible, and coinsurance structure — not our standard rate. We strongly recommend calling the member services number on the back of your insurance card before your first appointment to verify your mental health benefits and any prior authorization requirements.

If You Are Self-Pay or Uninsured

If you do not have insurance, or if you choose not to use insurance for these services, our standard rates above apply. You will receive a written Good Faith Estimate before your first appointment. Payment is due at the time of service.

Out-of-Network Reimbursement

If you have insurance but we are not in your network, you may be able to submit for partial reimbursement as an out-of-network benefit. We can provide you with a superbill — an itemized receipt with the CPT and diagnosis codes your insurance requires — which you submit directly to your plan. Reimbursement amounts and processes vary by plan. We cannot guarantee reimbursement or submit claims on your behalf for out-of-network plans.

6. Your Right to Dispute

How to Dispute a Bill

1. You must initiate a dispute within 120 calendar days of receiving your bill.
2. Contact the U.S. Department of Health & Human Services (HHS) dispute resolution portal at cms.gov/nosurprises or call 1-800-985-3059.
3. An independent dispute resolution entity will review the Good Faith Estimate and the actual bill, and make a binding decision.
4. There is a small administrative fee to use the dispute process (currently set by HHS — check the CMS website for the current amount).

You are not required to pay the disputed portion of the bill while the dispute is pending.

You will not be subject to retaliation, denial of care, or any negative consequence for exercising your right to dispute.

Before Filing a Dispute

If you receive a bill that is higher than expected, please contact us first. Billing discrepancies are often the result of a coding or administrative error that we can resolve quickly without the formal dispute process. We are committed to transparency and will work with you to address any concerns.

• Phone: (656) 789-3112
• Email: douglascarmody@nowandzenwellness.com

7. How to Request Your Estimate

You are entitled to a Good Faith Estimate in the following situations:

• Before scheduling: Ask for an estimate before you commit to care. We will provide one within 3 business days of your request.
• After scheduling (10+ days out): We will provide a written GFE at least 3 business days before your first appointment.
• After scheduling (3–9 days out): We will provide a written GFE at least 1 business day before your first appointment.

Your estimate will be delivered by email or in writing — whichever you prefer. You may keep a copy for your records. We will also retain a copy in your file.

To request a Good Faith Estimate, contact us by phone or email:

• Phone: (656) 789-3112 — Monday through Friday, 8:00 AM to 5:00 PM
• Email: douglascarmody@nowandzenwellness.com
• Contact form: nowandzenwellness.com/contact

Please include your name, the service(s) you are interested in, and whether you will be self-pay or using insurance. We will respond within one business day.

8. Contact Information

For questions about this notice, your Good Faith Estimate, billing, or your rights under the No Surprises Act:

• Provider: Douglas Carmody, LCSW
• Practice: Now & Zen Wellness
• Address: 14021 N Dale Mabry Hwy, Tampa, FL 33618
• Phone: (656) 789-3112
• Email: douglascarmody@nowandzenwellness.com
• Hours: Monday – Friday, 8:00 AM – 5:00 PM ET
• Florida LCSW License: #SW24424

For general information about your rights under the No Surprises Act:

• CMS No Surprises Act resource center: cms.gov/nosurprises
• CMS consumer helpline: 1-800-985-3059