Regulatory Disclosure

No Surprises Act & Good Faith Estimate

Provider: Hina Ansari, LPCC

Practice: The Healing Light Therapy LLC

Service delivery: Telehealth only, for clients located in Ohio, Texas, Florida, Minnesota & Indiana

Licensure: E:2202965 (Ohio) · also licensed in Texas, Florida, Minnesota and Indiana

NPI 2: 1144996505

"No Surprises" Act Notice & Good Faith Estimate

Effective January 1, 2022, laws regulating client care require healthcare providers to furnish current and potential self-pay clients with a "Good Faith Estimate" (GFE) for the cost of treatment prior to scheduled services or upon request.

Who Qualifies as a Self-Pay Patient?

This applies to any individual who does not have benefits under a health insurance plan or chooses not to use their insurance coverage. This regulation helps protect patients from unexpected out-of-pocket medical bills.

Good Faith Estimate Details

While therapy duration varies based on individual needs, in the interest of transparency, the following details outline our standard session fees and potential annual cost estimates for illustrative purposes.

Session fee schedule by CPT code

CPT Code Service Details Fee
90791 Intake Assessment Required for new clients; performed once per year $200
90837 Follow-up Session 53+ minutes $160
90834 Follow-up Session 45 minutes $140
90832 Follow-up Session 16–30 minutes $120
— Couples Sessions Not covered by insurance $200
— Treatment Planning Included every 3 months No additional cost

Sample cost estimates for illustrative purposes:

Sample cost estimates by session duration and frequency

Session Frequency Estimated Cost
53+ minutes ($160/session) Weekly (50 weeks/year) $8,000
53+ minutes ($160/session) Biweekly (25 sessions/year) $4,000
45 minutes ($140/session) Weekly (50 weeks/year) $7,000
45 minutes ($140/session) Biweekly (25 sessions/year) $3,500
45 minutes ($140/session) Weekly for 3 months (12 sessions) $1,680
45 minutes ($140/session) Biweekly for 3 months (6 sessions) $840
16–30 minutes ($120/session) Weekly (50 weeks/year) $6,000
16–30 minutes ($120/session) Biweekly (25 sessions/year) $3,000
16–30 minutes ($120/session) Weekly for 3 months (12 sessions) $1,440
16–30 minutes ($120/session) Biweekly for 3 months (6 sessions) $720

EMDR Intensive packages are billed separately as flat-fee, cash-pay services: 6-hour Intensive $1,200; 8-hour Intensive $1,600; 3-day Intensive (18 hours) $3,600. All major credit cards accepted.

Actual treatment duration and frequency depend on individual client needs. Estimates do not include unexpected costs from complications or special circumstances. Clients have the right to dispute charges through the US Department of Health and Human Services (HHS) within 120 days of the original bill.

Questions About Session Costs

If you have any questions about the cost of your sessions, please call or email: 440-252-2684 · [email protected]