Good Faith Estimate

Last updated July 7, 2026

Your Right to a Good Faith Estimate

Under the No Surprises Act, you have the right to receive a Good Faith Estimate of expected costs before receiving healthcare services. Ki Therapy provides this estimate to all clients before services begin.

What Is a Good Faith Estimate

A Good Faith Estimate is a written summary of expected costs for services. It is not a contract and does not guarantee a specific number of sessions. Actual costs may vary based on your individual clinical needs and the length of treatment.

Ki Therapy Fee Schedule

Individual Therapy

75 minutes | $200 per session

Reduced Fee

A limited number of reduced fee appointments are available for those who demonstrate financial need. Current availability and reduced rates are discussed during the scheduling process.

Late Cancellation and No-Show Fee

Cancellations made within 24 hours of a scheduled session or arrivals more than 15 minutes late are charged the full session rate of $200. This fee is not reimbursable by insurance.

Medical Records and Documentation Fee

$40 per document requested. This includes medical records requests, letters, and other clinical documentation. Documentation fees are due upon request.

Frequency of Services

The number of sessions recommended varies by individual clinical need and is discussed collaboratively with your therapist. Research suggests meaningful progress typically begins between sessions 6 and 8. Ki Therapy does not require a minimum number of sessions.

How You Will Receive Your Good Faith Estimate

A personalized Good Faith Estimate will be provided to you through the Sessions Health client portal before your first session. It will include the expected cost of services based on your specific clinical presentation and agreed upon session frequency.

To request a Good Faith Estimate before scheduling please contact Ki Therapy at (818) 554-0675.

Dispute Resolution

If you receive a bill that is substantially higher than your Good Faith Estimate you have the right to dispute the charge. A bill is considered substantially higher if it exceeds your Good Faith Estimate by more than $400.

For information about the dispute resolution process please visit:
cms.gov/nosurprises

Contact

Danielle Alexandria Pagan, LCSW
Ki Therapy
(818) 554-0675

Legal Disclaimer

This Good Faith Estimate is provided in compliance with the No Surprises Act. It does not constitute a contract for services. For questions about your rights under the No Surprises Act please visit cms.gov/nosurprises.