GOOD FAITH ESTIMATE

Oasis Therapy NJ

Effective Date: July 2026

Your Right to a Good Faith Estimate

Under the No Surprises Act (effective January 1, 2022), you have the right to receive a "Good Faith Estimate" explaining how much your mental health care will cost before you begin services.

Who This Applies To

This right applies to you if:

  • You are uninsured, OR

  • You are insured but choose not to use your insurance for services at this practice (private pay / self-pay)

Oasis Therapy NJ is an out-of-network, private pay practice. We do not bill insurance directly. As a courtesy, we can provide you with a superbill (itemized receipt) that you may submit to your insurance company for potential out-of-network reimbursement. However, reimbursement is not guaranteed and is determined solely by your insurance plan.

What the Good Faith Estimate Includes

Before beginning services, you are entitled to receive a written Good Faith Estimate that includes:

  • Expected costs for services over a 12-month period

  • The diagnosis, procedure codes, and service descriptions

  • Expected frequency and duration of sessions

You may request a Good Faith Estimate at any time — before scheduling your first appointment or at any point during treatment.

Current Session Fees

Our current fees are provided during the initial consultation and in your intake paperwork. Fees are subject to periodic review, and you will be notified of any changes in advance.

If Your Bill Is Higher Than Your Estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. For questions or to initiate a dispute, contact us directly or visit: www.cms.gov/nosurprises

How to Request a Good Faith Estimate

To request a written Good Faith Estimate prior to scheduling or at any point during care, please contact us:

Oasis Therapy NJ | Michelle Mouhtis, LCSW, LCADC
Matawan, NJ | oasistherapynj.com

Oasis Therapy NJ is a trade name of Michelle Mouhtis LCSW LLC, a New Jersey limited liability company.

We will provide your Good Faith Estimate in writing within 3 business days of your request, or no later than 1 business day before your scheduled appointment.

This notice is for informational purposes and does not constitute a contract for services. For questions about your rights under the No Surprises Act, visit www.cms.gov/nosurprises or call 1-800-985-3059.