Provider: Sabita Nandy, LMFT
Practice Name: Sabita Nandy LLC
Contact: sabitanandy@sabitanandy.com
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
When you receive care from a healthcare provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
Under the No Surprises Act, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
For uninsured (self-pay) patients or patients not using insurance:
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through a federal patient-provider dispute resolution process. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Type of Service: Psychotherapy/Mental Health Counseling
Service Location:
125 South Wacker Drive Suite 308 Chicago, IL 60606
1525 East 53rd Street Suite 433 Chicago, IL 60615 or Telehealth
Note: Most clients find meaningful resolution to their core concerns within 6 months (approximately 24 sessions). However, your individual treatment needs may vary, and the actual number of sessions required will be determined collaboratively based on your progress and goals.
Insurance Plans Accepted:
Your Out-of-Pocket Costs Will Depend On:
Estimated Out-of-Pocket Costs Per Session (Insurance):
Action Required: Please contact your insurance company to verify:
Insurance Verification: We can help verify your benefits before your first session.
This is an estimate only. The actual services and charges may differ from this estimate based on:
Therapy is individualized. The number of sessions needed varies by person. Some clients achieve their goals in fewer sessions, while others benefit from longer-term support.
Cancellation Policy: Sessions cancelled with less than 24 hours notice may be charged at the full session rate and are typically not covered by insurance.
Missed Appointments: Missed appointments without prior notice will be charged the full session rate.
Payment Methods Accepted:
Payment Timing:
Insurance Claims: For in-network insurance clients, we will bill your insurance directly. You are responsible for any copay, coinsurance, or deductible as determined by your insurance plan.
Out-of-Network Reimbursement: If you have out-of-network benefits and choose to use them, we can provide you with a superbill to submit to your insurance company for potential reimbursement. Reimbursement rates vary by plan.
If you have questions about this Good Faith Estimate or your expected charges, please contact:
Sabita Nandy, LMFT
Sabita Nandy LLC
Email: sabitanandy@sabitanandy.com
Phone: 312-607-4277
For questions about your rights under the No Surprises Act:
A late cancellation fee of $100.00 will be charged if session is cancelled within 24 hours of scheduled time.
National Suicide Prevention Lifeline: 988
Crisis Text Line: Text HOME to 741741
SAMHSA National Helpline: 1-800-662-4357
This Good Faith Estimate is provided in compliance with the No Surprises Act (effective January 1, 2022). For more information about your rights, visit www.cms.gov/nosurprises
Last Updated: January 2026
