Good Faith Estimate Notice
Effective Date: May 14th, 2026
Your Right to Receive a Good Faith Estimate
Under the No Surprises Act, health care providers are required to provide uninsured or self-pay clients with a Good Faith Estimate of expected charges for scheduled health care services.
This means that if you do not have insurance, or if you choose not to use insurance to pay for services, you have the right to receive an estimate of the expected cost of your care before receiving services.
About This Notice
This notice explains your right to receive a Good Faith Estimate from Dragonfly Counseling & Wellness, LLC.
A Good Faith Estimate is not a bill. It is an estimate of the expected charges for services reasonably anticipated at the time the estimate is created. Actual charges may vary depending on the services you receive, the number of sessions attended, changes in treatment needs, cancellations, additional services, or other circumstances.
Practice Information
Dragonfly Counseling & Wellness, LLC
850 Michigan Avenue
Columbus, Ohio 43215
Email: info@dragonflycw.com
Standard Service Rates
The following are current standard rates for services offered by Dragonfly Counseling & Wellness. These rates are provided for general informational purposes and may be used to help estimate expected costs.
| Service | Expected Charge |
|---|---|
| Individual Therapy – First Session | $175 |
| Individual Therapy – Follow-up Session | $140 |
| Relationship Therapy – First Session | $225 |
| Relationship Therapy – Follow-up Session | $170 |
| Break-up to Break-through Program | 8 sessions – $520 |
| Gender Exploration Program | 10 sessions over 8 weeks – $1,600 |
| Strengthening the Connection | 2-day psychoeducation workshop – $2,750 |
| Finding Resilience | 12 sessions – $3,600 |
Examples of Estimated Costs
The total cost of therapy depends on the type of service, frequency of sessions, and length of care. The following examples are estimates only.
| Example Course of Care | Estimated Cost |
|---|---|
| Individual Therapy: First session plus 3 follow-up sessions | $595 |
| Individual Therapy: First session plus 7 follow-up sessions | $1,155 |
| Relationship Therapy: First session plus 3 follow-up sessions | $735 |
| Relationship Therapy: First session plus 7 follow-up sessions | $1,415 |
| Break-up to Break-through Program | $520 |
| Gender Exploration Program | $1,600 |
| Strengthening the Connection | $2,750 |
| Finding Resilience | $3,600 |
When You Will Receive a Good Faith Estimate
If you are uninsured or self-pay, Dragonfly Counseling & Wellness will provide a Good Faith Estimate when required by law, including when you schedule services in advance or request an estimate.
If you schedule a service at least three business days before the date of service, you may be entitled to receive a Good Faith Estimate within the applicable legal timeframe.
You may also request a Good Faith Estimate before scheduling services.
What May Affect Your Final Cost
Your actual cost may vary based on several factors, including:
- The type of service provided
- The number of sessions attended
- The frequency of sessions
- Changes in treatment goals or clinical needs
- Additional services requested
- Missed appointment or late cancellation fees, where applicable
- Changes to Dragonfly Counseling & Wellness rates
Not a Contract
A Good Faith Estimate is not a contract and does not require you to receive services from Dragonfly Counseling & Wellness or from any provider listed in the estimate.
If Your Bill Is Higher Than Your Estimate
If you receive a bill that is substantially higher than your Good Faith Estimate, you may have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process.
For questions or more information about your rights under the No Surprises Act, visit https://www.cms.gov/nosurprises.
How to Request a Good Faith Estimate
You may request a Good Faith Estimate by contacting Dragonfly Counseling & Wellness:
Email: info@dragonflycw.com
Address: 850 Michigan Avenue, Columbus, Ohio 43215
Questions
If you have questions about service rates, expected costs, superbills, or your Good Faith Estimate, please contact us before beginning services.