Fees & Good Faith Estimate

Effective Date: June 24, 2026; Updated August 21, 2026

Your Right to a Good Faith Estimate

If you are paying for therapy yourself, you have a federal right to know what it will cost before you begin — in writing, at no charge, and without having to ask twice.

Trellis Therapy of Loudoun is a private-pay practice. We are out of network with all insurance plans, which means nearly every client here is entitled to a Good Faith Estimate. We provide one to every new client as part of intake, and to any current client who asks. We publish our fees here so you know what therapy costs before you reach out, and so you can weigh that against what your out-of-network benefits may reimburse.

Every person’s course of therapy is different. How long and how often you come is shaped by your schedule, therapist availability, what is going on in your life, and your finances. We talk about that openly, and we put it in writing in your Good Faith Estimate.

You have the right to receive a “Good Faith Estimate” explaining how much your medical 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 bill for medical items and 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.

How this works at Trellis Therapy of Loudoun

Every client at this practice is a private-pay client, so this applies to everyone we see. Your estimate covers a defined period — typically from your first session through December 31 of that year — and assumes weekly sessions at the current rate, or your sliding-scale rate if one applies. Not everyone meets weekly.

When you will receive one. You do not need to request an estimate to get one — we issue it automatically. If you do ask, here is how quickly it arrives.

• You schedule at least 3 business days ahead - Within 1 business day

• You schedule at least 10 business days ahead - Within 3 business days

• You ask for one without scheduling - Within 3 business days

Where services are received. Your estimate names the location: in person at 20915 Ashburn Road, Suite 215, Ashburn, VA 20147, or online by telehealth, in which case the location is the state you are physically in during the session. The fee is identical either way.

What the estimate does include. A Good Faith Estimate reflects the cost of services reasonably expected at the time it is issued. Your estimate lists each service we expect to provide, its billing code, our fee for it, and how many sessions we reasonably expect over the period it covers. It is based on what we know when we write it.

What the estimate does not include. Administrative services, crisis sessions, legal or court fees, coordination of care with other providers are not reflected in it. It is an estimate, not a bill, not a contract, and not a guarantee of the number of sessions that will occur or the final amount you will owe. Therapy length varies, and the plan can change as we go. You will get a new estimate whenever the expected cost of your care changes significantly, and any time you request one.

Session Fees

Service CPT Session Length Fee__
Initial diagnostic evaluation 90791 Typically 60 minutes $225
Psychotherapy session 90837 53 minutes or more $200
Psychotherapy session 90834 38–52 minutes $175
Psychotherapy session 90832 16–37 minutes $150
Family therapy, client present 90847 50 minutes or more $200
Family therapy, client not present 90846 50 minutes or more $200
Administrative services (e.g., Per 15 minutes $75
letters, reports, consultation with
another provider)
Court testimony and legal services Per hour, two-hour $500
minimum retainer
paid in advance

Sessions are billed by the time actually spent in session, not by the length of the appointment slot. A returned or failed payment adds a $75 fee to your balance. Fees change only with at least 30 days' written notice.

Payment. Due at the time of your session. We accept credit and debit cards, HSA and FSA cards, and cash. Card payments run through Ivy Pay, a HIPAA- and PCI-compliant processor built for mental health practices — you enter your card directly from your own device, and this practice never sees or stores your full card number.

Insurance and superbills. We are out of network with all plans and do not submit claims. On request we provide a monthly superbill — an itemized statement you can submit to your insurer for possible out-of-network reimbursement. Doing so means sharing a mental health diagnosis code with your insurer, and if your insurer denies or limits reimbursement, the full fee remains your responsibility.

If cost is a barrier. Tell us, early if you can. Payment plans and a limited number of sliding-scale rates may be available. To be considered for a sliding-scale rate, ask, and provide the documentation we request — usually proof of income or household size. Eligibility is reviewed every six months, or sooner if your circumstances change. If we cannot accommodate you, we will refer you to lower-cost services.

Cancellations. Appointments must be cancelled or rescheduled at least 48 hours in advance. If you give less notice, or do not attend, we may charge a late cancellation or no-show fee at your full session rate, at your clinician's discretion. Insurance does not reimburse it.

If your bill comes in higher than your estimate

Contact us first, if you would rather. You can ask us to update the bill to match the estimate, ask to negotiate it, or ask whether financial assistance is available. We would rather resolve it with you directly.

You also have the right to dispute the bill. If you are billed at least $400 more than your Good Faith Estimate, you may start the patient-provider dispute resolution process with the U.S. Department of Health and Human Services within 120 calendar days — about four months — of the date on your original bill.

There is a small administrative fee to use the process, which may be reduced or waived depending on income; the current amount is set by HHS and published at www.cms.gov/nosurprises. If the agency reviewing your dispute agrees with you, you pay the price on your Good Faith Estimate. If it agrees with the provider, you pay the higher amount.

Asking about cost, questioning your estimate, or filing a dispute will never affect your care. Your appointments will not be cancelled, delayed, rescheduled, or changed because you did any of those things.

To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 1-800-985-3059.

How to ask for one

Call, email, or mention it at any point — before scheduling, at intake, or partway through treatment. There is no form to fill out and no reason you need to give.

Michelle Brueser, LCSW, LICSW, LCSW‑C, LCAS
(571) 746‑5366
info@trellisloudoun.com
20915 Ashburn Road, Suite 215, Ashburn, VA 20147

Other formats

If you need this notice, your Good Faith Estimate, or any of our forms in large print, in another language, read aloud, or in another accessible format, contact us. There is no charge.

If you need an interpreter for a session or for a conversation about cost, tell us and we will arrange it at no cost to you. Email info@trellisloudoun.com.

This notice is provided under Section 2799B-6 of the Public Health Service Act and its implementing regulations at 45 C.F.R. § 149.610; the dispute resolution process described above is set out at 45 C.F.R. § 149.620. Last reviewed August 21, 2026.