Good Faith Estimate

This Good Faith Estimate is provided by Laura Robinson Therapy, PLLC in compliance with the No Surprises Act and Texas law.

The purpose of this estimate is to outline the expected costs of services that are reasonably anticipated for your mental health care needs. The estimate is based on the information known at the time of scheduling. It is not a contract and does not obligate you to receive services.

Your Rights

  • You have the right to request an updated estimate at any time.

  • The number of sessions listed is an estimate based on your current treatment plan. Your provider may recommend additional sessions based on your clinical needs.

  • If the number or frequency of sessions changes significantly, or if total estimated charges are expected to increase by $400 or more, you will be informed and provided with a revised estimate.

  • You will be asked to review and sign the updated estimate before continuing with additional services.

  • Your continued participation in psychotherapy will require your consent to the revised treatment plan and associated costs.

Important Information

  • You are not required to receive services from this provider.

  • This estimate is not a bill. You will only be billed according to your actual use of services.

  • If you are billed at least $400 more than this estimate, you have the right to dispute the bill under federal law.

Dispute Resolution

If you receive a bill from Laura Robinson Therapy, PLLC that is at least $400 more than this estimate, you may initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS) within 120 days of the billing date.

  • There is a $25 fee to use the dispute process.

  • If the reviewing agency agrees with you, you will only be responsible for the charges listed in this estimate.

  • If the agency disagrees with you and sides with the provider, you will be responsible for the higher billed amount.

To start a dispute:

Client Acknowledgment

I acknowledge that I have received a Good Faith Estimate for mental health services from Laura Robinson, LCSW, at Laura Robinson Therapy, PLLC.
I understand that this is an estimate, not a guarantee of final costs.