Good Faith Estimate
Seele Collective, LLC
Counseling services provided by Allison Gidusko, MS, LAPC
Pennsylvania · primarily telehealth
This page explains your federal rights to a Good Faith Estimate of expected charges when you are uninsured or self-pay (you have insurance but are not using it to pay for Seele’s services). It is an informational page. It is not an individualized estimate or a bill.
Seele is currently primarily private-pay / self-pay while working toward participation with select insurance plans. Individual Good Faith Estimates are provided separately when required.
For official federal information, see:
and https://www.cms.gov/nosurprises/consumers
Who can get a Good Faith Estimate?
You are generally entitled to a Good Faith Estimate if:
you do not have health insurance, or
you have health insurance but are not using it to pay for Seele’s services (self-pay).
If you will use insurance for your care, different rules may apply; talk with Seele about billing and benefits verification as needed.
When is a Good Faith Estimate provided?
Under the federal No Surprises Act rules for uninsured and self-pay individuals, providers generally must provide a Good Faith Estimate:
when care is scheduled at least 3 business days in advance, or
when you ask for an estimate (you do not need to use the exact phrase “Good Faith Estimate”).
Emergency care is treated differently under federal guidance; Seele is a counseling practice and does not operate an emergency department.
What a Good Faith Estimate is — and is not
A Good Faith Estimate is a written list of expected charges for scheduled health care items or services before you receive them.
It is not a bill.
It is not a guarantee that your care will be limited to the listed services. If your needs change, additional or different services may be recommended, and those may not have been included in the original estimate.
A Good Faith Estimate from Seele typically relates to counseling services with this practice (for example, expected session fees for scheduled care). Currently, federal estimates generally list expected charges for a single provider or facility. If other providers would be involved in your care, you may need to request estimates from them separately.
This website does not publish a generic estimated treatment total. Your individual Good Faith Estimate will be provided to you in writing when required.
How to request an estimate from Seele
You can request a Good Faith Estimate by contacting Seele:
Email: seelecollective@gmail.com
Phone: (717) 965-5907
Please tell us that you are uninsured or self-pay (not using insurance for these services) and what services you are scheduling or considering.
Keep your written estimate. You may need it to compare with a later bill and, if eligible, to use the federal patient-provider dispute process.
If your bill is much higher than the estimate
If you received a Good Faith Estimate and later receive a bill from that same provider that is at least $400 more than the estimate, federal rules may allow you to dispute the bill through the patient-provider dispute resolution process.
Key federal points:
You generally must start a dispute within 120 calendar days of receiving the initial bill.
There is typically an administrative fee to initiate the federal process (CMS materials currently describe a $25 fee in connection with initiating a dispute).
An independent third party reviews the dispute.
Learn more and find dispute resources:
https://www.cms.gov/nosurprises/consumers
Consumer help line referenced by CMS materials: 1-800-985-3059
This website page does not start a dispute and does not calculate whether any particular bill qualifies.
Questions
If you have questions about estimates, fees, sliding-scale availability, or how private-pay billing works at Seele, please contact us before or when you schedule care.
Based on current CMS/HHS consumer guidance under the No Surprises Act regarding Good Faith Estimates for uninsured and self-pay individuals. This page is not an individualized Good Faith Estimate.