Good Faith Estimate
Last updated September 2026.
Under the federal No Surprises Act, people who are uninsured or who choose not to use insurance have the right to know, in writing and in advance, what their healthcare is expected to cost. This page explains how that right works in my practice. Questions are always welcome at xsana@xsanasaphire.com.
What a Good Faith Estimate is
A Good Faith Estimate is a written statement of the expected charges for your care — the fee per session and the anticipated cost over a course of treatment. It is not a bill and not a contract; it is a good-faith projection, so that cost is never a surprise. Because my clinical practice, Holistic Healing & Therapy, is self-pay only, every therapy client has this right.
What you can expect
A written estimate before we begin
— before your first therapy session, you receive a Good Faith Estimate in writing. You can also request one at any time, before or after scheduling.The session fee, stated plainly
— therapy is $155 per 50-minute session. My practice is self-pay and does not bill insurance, so this is the rate your estimate is built on.An updated estimate if anything changes
— if the fee or the expected course of care changes, you receive a revised estimate before the change applies. Keep a copy of every estimate you’re given.
If a bill is higher than the estimate
If you receive a bill that is at least $400more than your Good Faith Estimate, federal law gives you the right to dispute it through the patient–provider dispute resolution process. Start by contacting me — most questions resolve in a conversation — and keep your copy of the estimate, since the dispute process compares the bill against it.
Where to learn more
The full text of your rights, and how to begin a dispute, is at www.cms.gov/nosurprises. You can also email me at xsana@xsanasaphire.comand I’ll walk you through it.
What this covers — and what it doesn’t
The Good Faith Estimate and the No Surprises Act apply to clinical therapy only— the licensed mental health care provided through Holistic Healing & Therapy. Rooted Within offerings — hypnotherapy for personal growth, Reiki, yoga, workshops, and retreats — are not healthcare services and are not covered by this notice; their fees and terms are set out in their own service agreements before you enroll.
Contact
Xsana Saphire Phoumiphat, MA, LCPC #CP5910 — Nevada (telehealth).
xsana@xsanasaphire.com