Your Right to Receive a Good Faith Estimate

Effective Date: October 6, 2026

Cinthia R. Taylor, LMFT, PLLC (Taylor Teletherapy) offers services on a private-pay basis. Under the federal No Surprises Act, health care providers must give clients who do not have insurance, or who are not using insurance, an estimate of the expected charges for their services.

•    You have the right to receive a Good Faith Estimate of the total expected cost of any non-emergency services, including psychotherapy.

•    You can ask for a Good Faith Estimate before you schedule a service, or at any time during treatment.

•    Timing. If you schedule a service at least 3 business days in advance, you will receive a written Good Faith Estimate within 1 business day of scheduling. If you schedule at least 10 business days in advance, or ask for an estimate without scheduling, you will receive it within 3 business days.

•    If you are billed more than expected, and the bill is at least $400 more than your Good Faith Estimate, you can dispute the bill.

•    Keep a copy. 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.

Current Fee Schedule

Your Good Faith Estimate will be based on the following fees and on the expected frequency and length of treatment we discuss together:

Individual therapy session................................................................................................................ $250

Couples therapy session.................................................................................................................. $300

EMDR session — 45 minutes............................................................................................................ $250

EMDR session — 60 minutes............................................................................................................ $300

Half-day EMDR intensive — 3 hours.................................................................................................. $900

KAP preparation session.................................................................................................................. $275

KAP dosing session — 2.5 hours........................................................................................................ $750

KAP integration session................................................................................................................... $275

Discounted KAP package bundles are available; please ask for details. A superbill can be provided upon request for clients seeking out-of-network reimbursement.

The Good Faith Estimate does not include any charges from other providers, such as fees from a prescribing provider, medication costs, or pharmacy charges for Ketamine-Assisted Psychotherapy.

Questions

Cinthia R. Taylor, LMFT, PLLC (Taylor Teletherapy)

352 Seventh Avenue, New York, NY 10001

Phone: (800) 224-9489

Website: taylorteletherapy.com/contact