GOOD FAITH ESTIMATE NOTICE
Effective Date: January 19, 2026
This notice explains your right to receive a Good Faith Estimate of expected charges for mental health services under federal law.
This notice applies to services provided by Olive Tree Therapy and Micol Gonella, PsyD.
Your Right to a Good Faith Estimate
If you are uninsured or choose not to use insurance (self-pay), you have the right to receive a Good Faith Estimate of the expected cost of psychotherapy services before services begin.
A Good Faith Estimate outlines anticipated charges based on the services reasonably expected to be provided. It is not a contract and does not guarantee final charges, which may vary if treatment needs change.
When You Will Receive a Good Faith Estimate
A Good Faith Estimate will be provided:
Before your first scheduled session, and
Upon request at any time during services
If services are scheduled at least three business days in advance, the estimate will be provided no later than one business day before services begin.
If You Receive a Higher Bill Than Expected
If you receive a bill that is $400 or more above your Good Faith Estimate, you may have the right to dispute the charges through the federal patient-provider dispute resolution process.
Information about this process will be provided with your Good Faith Estimate.
Questions or Requests
To request a Good Faith Estimate or ask questions about fees, please contact:
Micol Gonella, PsyD
Olive Tree Therapy
hello@olivetreestherapy.com