Good Faith Estimate

The following is a detailed list of expected charges for the Service or Item listed above.

Service/Treatment Fees:

$150 for Individual 50-minute Therapy Session;

$200 for Couple’s 75-minute Therapy Session;

$250 for Family 100-minute Therapy Session.

Healthcare Provider:

Dr. Carolyn Becker PhD, LMFT 

Address where service will be provided:

C Becker Therapy PLLC Mental Health – Psychotherapist

4700 Keller Hicks Rd Fort Worth, Texas 76244

Office Phone (817) 349-3898 NPI 1134584501 EIN 85-3472083 

DETAILS of SERVICES Individual counseling sessions are structured for personal reflection in a safe environment to examine hard subjects interfering with your life. Individual counseling works to create clarity and empower personal knowledge to address immediate concerns and goals. Marriage or couples counseling address the relationship and improve communication to find solutions. Our conversation will focus on strengthening self-empowerment and encourage the recognition of each partner’s personal responsibility. We will identify coping strategies and co-construct the tools necessary to heal the pain and stress associated with your personal life transitions. Family counseling provides a safe space for each member to find their voice and feel heard. This modality includes the attendance of the entire family to establish meaningful solutions. Family members may invite remote parents, ex-spouses, extended family, friends, teachers, neighbors, or others identified as contributing to the family dynamics.

Number of sessions estimated: 13 – Scheduled once per week for 90 days. Expected Cost per session: Total Estimated Cost for All Services:

Individual Session $150 x 13 = $1,950

Couple’s Session $200 x 13 = $2,600

Family Session $250 x 13 = $3,250:

Disclaimer: This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for a service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. This estimate does not take into consideration the client’s insurance deductible, co-payment, or coinsurance amounts.

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. To learn more and get a form to start the process, go to or call 1-800-985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit or call 1-800-985-3059.