Saranah Counseling

Good Faith Estimate Statement

Diane Dawson, LCSW, LLC d/b/a Saranah Counseling
Effective Date: September 15, 2026

Your Right to a Good Faith Estimate

Under the federal No Surprises Act, individuals who are uninsured or who choose not to use their health insurance may have the right to receive a Good Faith Estimate (GFE) of the expected cost of health care services.

Saranah Counseling is committed to providing clear information about the expected cost of services.

Who Receives a Good Faith Estimate?

A Good Faith Estimate generally applies when you:

• Do not have health insurance; or
• Have health insurance but choose not to use your insurance for the services.

If you are using insurance, your actual responsibility may depend on your insurance plan, deductible, copayment, coinsurance, authorization requirements, and other plan-specific factors.

Medicare and other government health coverage have separate rules regarding payment and cost estimates.

What Your Good Faith Estimate May Include

When applicable, your Good Faith Estimate will identify the expected charges for scheduled or requested services.

For ongoing behavioral health services, the estimate may be based on the services reasonably expected to be provided over a specified period of time.

A Good Faith Estimate is an estimate of expected charges, not a guarantee of the final amount you will owe.

The actual amount charged may differ if the services provided differ from those originally anticipated or if circumstances require changes in the course of treatment.

When You Will Receive Your Estimate

When required by law, Saranah Counseling will provide a Good Faith Estimate within the applicable federal timeframe based on when services are scheduled or when an estimate is requested.

You may request a Good Faith Estimate before scheduling services.

If you are considering treatment and would like an estimate of expected charges, please contact Saranah Counseling.

Disputing a Bill That Is Substantially Higher Than Your Estimate

If you are uninsured or self-pay and receive a bill that is substantially higher than your Good Faith Estimate, federal law may provide you with a right to dispute the bill through the federal patient-provider dispute resolution process.

Information about your rights and the applicable dispute-resolution process will be provided with your Good Faith Estimate when required.

Questions About Fees

Before beginning services, you are encouraged to ask about:

• The fee for the service;
• How frequently services are expected to occur;
• Whether insurance will be billed;
• Your expected financial responsibility;
• Deductibles, copayments, or coinsurance when applicable; and
• Good Faith Estimate requirements.

Saranah Counseling will make reasonable efforts to communicate expected charges clearly and in advance.

Contact

Diane Dawson, MSS, LCSW
Saranah Counseling
Diane Dawson, LCSW, LLC
Exton, Pennsylvania

Email: Diane@SaranahCounseling.com
Website: SaranahCounseling.com

This website statement is for general information. It does not replace an individualized Good Faith Estimate when one is required by law.

Effective Date: September 15, 2026