Good Faith Estimate

Effective Date: [9/2/25]

Under the federal No Surprises Act, healthcare providers are required to provide a Good Faith Estimate of expected charges for healthcare services to uninsured and self-pay patients, or those not using their insurance benefits.

Your Rights & Protections

You have the right to receive a Good Faith Estimate for the total expected cost of any scheduled healthcare services. This estimate includes:

  • The services planned for your treatment

  • The expected cost of those services

  • The billing codes for each service

This is an estimate only and not a contract. Your actual charges may differ from this estimate based on the specific services you receive during your treatment.

Alba Wellness Group Fee Schedule

Initial Assessments

  • Individual Initial Assessment (60 minutes): $200

  • Couples Initial Assessment (90 minutes): $250

  • Family Initial Assessment (120 minutes): $300

Follow-Up Sessions

  • Individual Therapy (45-55 minutes): $150

  • Couples Therapy (75-90 minutes): $175

  • Family Therapy (90 minutes): $200

Specialized Services

  • Ketamine-Assisted Therapy: Fee varies based on individual treatment plan (separate consultation required)

  • Anger Management Groups: Contact for current rates

  • EMDR Therapy: $150 per session (45-55 minutes)

Additional Services

  • Consultation Services: $150 per hour

  • Letters and Documentation: $50-$100 (depending on complexity)

  • Court Appearances or Testimony: $300 per hour (2-hour minimum)

Factors That May Affect Your Final Charges

Your actual costs may vary from this estimate due to:

Changes in Treatment

  • Additional services recommended during your care

  • Changes in session duration or frequency

  • Referrals to other specialists or services

  • Emergency or crisis interventions

Insurance Coverage

  • If you decide to use insurance benefits after beginning treatment

  • Changes in your insurance coverage or benefits

  • Prior authorization requirements or denials

Administrative Factors

  • Missed appointment fees (charged at full session rate with less than 24-hour notice)

  • Returned payment fees

  • Administrative time for complex documentation requests

Payment Policies

Payment Methods

We accept the following forms of payment:

  • Cash, check, or credit/debit card

  • Health Savings Account (HSA) or Flexible Spending Account (FSA) cards

  • Payment plans may be available (contact our billing department)

When Payment is Due

  • Payment is due at the time of service unless other arrangements have been made

  • For ongoing treatment, we may require a credit card on file for automatic billing

  • Unpaid balances may result in suspension of services

Insurance Considerations

  • These rates apply to self-pay patients or those not using insurance benefits

  • If you have insurance coverage, your out-of-pocket costs may be different

  • We recommend contacting your insurance provider to understand your benefits and coverage

Sliding Scale Options

We offer limited sliding scale options for qualified individuals based on:

  • Financial need and income verification

  • Availability with associate-level therapists

  • Completion of financial assistance application

Contact our office at (818) 741-2906 to inquire about sliding scale availability.

Example Treatment Scenarios

Scenario 1: Individual Therapy (3 months)

  • Initial Assessment: $200

  • 12 follow-up sessions: $1,800 (12 × $150)

  • Total Estimated Cost: $2,000

Scenario 2: Couples Therapy (6 months)

  • Initial Assessment: $250

  • 24 follow-up sessions: $4,200 (24 × $175)

  • Total Estimated Cost: $4,450

Scenario 3: EMDR Trauma Treatment (4 months)

  • Initial Assessment: $200

  • 16 EMDR sessions: $2,400 (16 × $150)

  • Total Estimated Cost: $2,600

Your Right to Dispute Charges

Under the No Surprises Act, you have the right to dispute charges that are substantially more than the Good Faith Estimate. You may be eligible for a dispute resolution process if:

  • Your final bill is at least $400 more than your Good Faith Estimate

  • You initiate the dispute within 120 calendar days of receiving the bill

Questions About Your Estimate

If you have questions about this Good Faith Estimate or need a personalized estimate for your specific treatment plan, please contact:

Alba Wellness Group
 Billing Department
Phone: (818) 741-2906
Email: info@albawellnessgroup.com

Office Locations:

  • 14500 Roscoe Blvd., Suite 400, Panorama City, CA 91402

  • 1601 West Avenue J #103, Lancaster, CA 93934

Additional Resources

For more information about your rights under the No Surprises Act:

  • Visit: www.cms.gov/nosurprises

  • Call: 1-800-985-3059

Insurance Accepted

While this Good Faith Estimate applies to self-pay patients, we do accept the following insurance plans:

  • Anthem

  • SoCal Kaiser

  • Aetna

  • United Healthcare

  • Optum

  • Oscar

  • Medicare

  • Tricare West

Note: Insurance coverage may significantly reduce your out-of-pocket costs. We recommend verifying your benefits and coverage details with your insurance provider before beginning treatment.

This Good Faith Estimate is not a contract and does not guarantee the final cost of your care. Actual charges may vary based on the services you receive during treatment.