Your Rights as a Client

Effective Date: May 17, 2026

At Affirmation for All Counseling, transparency is a core value. Knowing what to expect — financially, ethically, and clinically — is part of feeling safe in therapy. This page explains your rights as a current or prospective client, including your federal right to a Good Faith Estimate of expected costs under the No Surprises Act, your rights as a Florida mental-health client, and the protections you have when receiving services from this Practice.

1. Your Right to a Good Faith Estimate

Under the federal No Surprises Act (effective January 1, 2022), you have the right to receive a written Good Faith Estimate (“GFE”) of the total expected cost of any non-emergency healthcare service from any provider, including a mental-health counselor.

You are entitled to a Good Faith Estimate if you are uninsured, or if you are insured but choose not to use your insurance to pay for these services.

Affirmation for All Counseling is a private-pay practice and does not bill insurance directly. This means every client of this Practice is entitled to a Good Faith Estimate before services begin and at any time during care upon request.

What a Good Faith Estimate Includes

Your Good Faith Estimate will be provided in writing and will include:

Your name and date of birth
A description of the services that are reasonably expected (for example, individual counseling, Accelerated Resolution Therapy, group therapy)
The applicable diagnosis codes (when known) and service/procedure codes (CPT codes)
The expected charge per session
An estimate of the total number of sessions over a defined period of time (typically 12 months)
The total expected charges for the period covered by the estimate
Required federal disclaimers about your right to dispute charges that exceed the estimate by $400 or more
A statement that the estimate is not a contract and does not require you to obtain services from this Practice

When You Will Receive Your Good Faith Estimate

Federal rules require providers to give you a Good Faith Estimate within the following timeframes:

If you schedule a service at least 3 business days in advance: within 1 business day after scheduling
If you schedule a service at least 10 business days in advance: within 3 business days after scheduling
If you request an estimate (without yet scheduling): within 3 business days of your request

You may also request an updated Good Faith Estimate at any time during the course of treatment, and we will provide a new one at least every 12 months for ongoing care, or sooner if expected charges change.

How a Good Faith Estimate Is Provided

Your Good Faith Estimate will be provided in writing through our secure client portal (SimplePractice) as part of your intake paperwork. We can also email it as a PDF, mail it to you, or hand it to you in person upon request. If you have a preferred language other than English, please let us know and we will do our best to accommodate.

2. Estimated Fees and Service Information

The following are the current rates and standard service durations at Affirmation for All Counseling. These figures form the basis of the Good Faith Estimate provided at intake. Fees are subject to change with reasonable advance notice; the rates in effect at the time of your appointment are the rates that will apply.

Initial Consultation

Free · 30 minutes · Virtual

Individual Counseling

$125 · 50 minutes · Virtual or in-person (walk & talk)

Accelerated Resolution Therapy (ART)

$150 · 90 minutes · In person

LGBTQ+ Process Group

$30 · 90 minutes · Group format

Service codes commonly used: CPT 90791 (initial diagnostic evaluation), CPT 90834 (45–50 minute individual psychotherapy), CPT 90837 (60+ minute individual psychotherapy), CPT 90847 (family/couples psychotherapy with patient present, when applicable), CPT 90853 (group psychotherapy).

Diagnosis codes will be listed once a clinical evaluation has been completed. Diagnosis is a clinical decision and may evolve as we work together.

Example Estimate Language

Because therapy is collaborative and the length of treatment varies, a Good Faith Estimate for ongoing therapy will typically use language similar to one of the following examples:

“We expect treatment will involve weekly individual counseling sessions over the next 12 months at $125 per session, for a total estimated cost of $6,500 (52 sessions). This estimate excludes holidays, vacations, and unanticipated cancellations.”
“Depending on treatment progress, we expect a total of 10 to 20 individual counseling sessions in the next 12 months at $125 per session, for a total estimated cost between $1,250 and $2,500.”

Your individualized Good Faith Estimate will use the language and frequency that best fits your treatment plan. The actual cost may be lower or higher depending on how many sessions you choose to attend.

3. Your Right to Dispute a Bill

If you receive a bill from Affirmation for All Counseling that is at least $400 more than your most recent Good Faith Estimate for the same services, you have the right to initiate a Patient-Provider Dispute Resolution (PPDR) process with the U.S. Department of Health and Human Services (HHS).

To dispute a bill, you generally must:

Start the dispute process within 120 calendar days of the date on the original bill
Submit your dispute through the federal portal at www.cms.gov/nosurprises or by calling 1-800-985-3059
Pay a small administrative fee, which is refunded if the dispute is decided in your favor

During the dispute, an independent third-party reviewer determines an appropriate payment amount. Initiating a dispute will not affect the quality of services you receive from this Practice. We will continue to provide professional, ethical care regardless of any dispute.

For more information, visit www.cms.gov/nosurprises or call 1-800-985-3059.

4. Important Information About Good Faith Estimates

A Good Faith Estimate shows the costs of items and services that are reasonably expected for your treatment.
The estimate is based on information known at the time it is created. Actual charges may differ if your needs change, the frequency of sessions changes, additional services are added, or unforeseen circumstances arise.
The Good Faith Estimate does not include charges for any item or service that is not reasonably expected at the time it is created.
The Good Faith Estimate is not a contract. It does not obligate you to receive services from Affirmation for All Counseling, and you may discontinue services at any time.
Your Good Faith Estimate will be added to your medical record and retained for at least six (6) years, as required by federal regulations.

5. Your Right to Use Out-of-Network Insurance Benefits

Although Affirmation for All Counseling does not bill insurance directly, many clients have out-of-network mental-health benefits that may cover part of the cost of therapy. We can provide you with a superbill (an itemized receipt with diagnosis and service codes) that you may submit to your insurance company for possible reimbursement.

To make this easier, the Practice partners with Thrizer, an independent service that automatically files superbills on your behalf and, after you meet your deductible, allows you to pay the reduced out-of-network rate at the time of session. You can check your out-of-network benefits at: https://eligibility.thrizer.com/affirmationforallcounseling

Use of Thrizer is optional. Whether or not you use insurance is your choice, and your right to a Good Faith Estimate applies whenever you choose not to bill your insurance for these services.

6. Your Rights Under Florida Law

As a client of a Florida mental-health professional, you have additional rights under Chapter 491, Florida Statutes, and the rules of the Florida Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling. These include:

The right to confidentiality. Your communications with your therapist are confidential, with limited exceptions including suspected abuse or neglect of a child, elder, or vulnerable adult; serious imminent risk of harm to yourself or another identifiable person; valid court orders; and other circumstances required by Florida and federal law.
The right to access your record. Under Section 456.057, Florida Statutes, you have the right to a copy of your clinical record. Records are kept for at least 7 years after the date of last contact (or longer for minors, until they reach age 26).
The right to informed consent. You have the right to be informed of the qualifications of your therapist, the nature of services provided, the limits of confidentiality, and the risks and benefits of treatment before consenting to services.
The right to know your therapist’s credentials. Therapy at Affirmation for All Counseling is provided by Nat Bartlett, a Registered Mental Health Counselor Intern in Florida (RMHCI License #24881), under the qualified supervision of Shana Sopko, LMHC (Florida License #MH15184). “Intern” is a Florida regulatory designation indicating that Nat has completed a master’s degree in mental-health counseling and is gaining the post-graduate clinical hours required for full licensure. All clinical work is overseen by a licensed supervisor.
The right to end services at any time. You may end therapy at any time and for any reason, and you have the right to a referral to another provider upon request.
The right to be free from discrimination. You have the right to receive services free from discrimination based on race, color, national origin, age, disability, sex, sexual orientation, gender identity, gender expression, religion, or any other protected characteristic.
The right to file a complaint. If you believe a Florida mental-health professional has acted unethically or unlawfully, you may file a complaint with the Florida Department of Health, Division of Medical Quality Assurance, at 1-888-419-3456 or online at flhealthsource.gov.

7. Your Rights Under HIPAA

Affirmation for All Counseling complies with the Health Insurance Portability and Accountability Act (HIPAA) and other applicable federal and state privacy laws. Under HIPAA, you have the right to:

Receive a Notice of Privacy Practices that describes how your protected health information (PHI) is used and disclosed
Request access to and copies of your PHI
Request amendments to your PHI if you believe it is inaccurate
Request restrictions on certain uses or disclosures
Request confidential communications by alternative means or at alternative locations
Receive an accounting of certain disclosures of your PHI
File a complaint with us or with the U.S. Department of Health and Human Services if you believe your privacy rights have been violated

You will receive the full Notice of Privacy Practices as part of your intake paperwork.

8. Cancellation and Missed-Appointment Policy

Because therapy time is reserved specifically for you, the Practice maintains the following cancellation policy:

At least 72 hours’ advance notice is required to cancel or reschedule an appointment.
Appointments cancelled with less than 72 hours’ notice are charged the full session fee.
Each client receives one free missed session or late cancellation per year.

Late-cancellation and no-show fees are not covered by insurance and are billed directly to you. They are not included in the Good Faith Estimate, because they are not a service that is expected to occur.

9. Sliding Scale and Reduced Fees

A limited number of sliding-scale spots are available for clients who need a reduced fee. Availability depends on current schedule and capacity. If you are interested in a sliding-scale spot, please ask during your consultation. The agreed sliding-scale rate, if applicable, will be reflected in your Good Faith Estimate.

10. Emergencies and Crisis Resources

Affirmation for All Counseling does not provide emergency or 24/7 crisis services. If you are experiencing a mental-health emergency, please use one of the following resources:

988 Suicide and Crisis Lifeline — call or text 988 (24/7)
Crisis Text Line — text HOME to 741741 (24/7)
The Trevor Project — 1-866-488-7386 or text START to 678-678 (LGBTQ+ youth crisis support)
Trans Lifeline — 1-877-565-8860 (peer support by and for trans people)
LGBT National Hotline — 1-888-843-4564
Call 911 or go to your nearest emergency room for immediate danger

11. Required Federal Disclaimer

The following federal disclaimer is required to be included with every Good Faith Estimate:

“You have the right to receive a Good Faith Estimate explaining how much your medical care will cost. Under the law, healthcare 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 healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your healthcare 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.”

12. Questions

If you have any questions about your rights as a client, the Good Faith Estimate process, your bill, or any other aspect of working together, please contact us. We are happy to talk it through with you.

Affirmation for All Counseling

Nat Bartlett, Registered Mental Health Counselor Intern

Florida RMHCI License #24881

Email: nat.afacounseling@protonmail.com

Website: https://www.affirmationforallcounseling.org

Under the qualified supervision of Shana Sopko, LMHC – Florida License #MH15184.

This page is for informational purposes only and is not legal advice. It is intended to satisfy the disclosure requirements of the No Surprises Act (45 CFR 149.610) and to inform clients of their rights under federal and Florida law.