The Good Faith Estimate

 Good Faith Estimate for Self-Pay / Out-of-Pocket / Out-of-Network Services

Fawn Workman, NP LLC DBA Lifesong Health and Hello Hope
14805 Forest Rd, Suite 107A, Forest, VA 24551
Phone: 424-260-3380
Email: [email protected]
NPI: 1932830650 | TIN: 81-4219052

Date of Estimate: (see below for date signed- issued at time of appointment or prior to first appointment. ) Estimate valid for: 12 months from date of issue

Purpose of This Estimate
This Good Faith Estimate (GFE) outlines the anticipated costs for services provided by Lifesong Health providers to patients who are not using insurance, including those who are self-pay, out-of-network, or electing not to submit claims. This estimate is based on current information available and reflects typical care patterns over a 12-month period.

Scope of Services
Services may include any combination of the following based on your needs and goals:

• Mental health and psychiatric services (e.g., evaluation, medication management, supportive therapy)
• Wellness or integrative care (e.g., lifestyle coaching, nutrition counseling, functional medicine, weight management)
• This estimate does not include prescribed or recommended supplements, labs, prescriptions, or programs
  

The number and type of sessions are determined collaboratively based on clinical necessity and patient preference.

Estimated Frequency and Costs
Service Category        Mental Health & Wellness Services

Estimated Frequency per Year   5 to 40 sessions

Cost per Session         $150 to $500 per session                

 Estimated Annual Total $1,500 to $15,000

Note: This estimate reflects a range of possible care patterns. Final costs may vary depending on visit length, complexity, or combined service needs.
Important Billing & Insurance Notes

• All new patients are seen on a self-pay basis. At this time, we are not accepting new insurance patients, except through a waitlist for Alma or Headway.
• Existing patients using Alma or Headway should continue to direct billing questions to those platforms.
  
• As of 8/18/25, we are currently in-network with Sentara Health Plans, but transitioning this relationship to Headway.
• We do not currently serve Medicare patients and are in the process of formally opting out of Medicare.
  

Disclaimer
This Good Faith Estimate shows the costs of items and services that are reasonably expected for your care based on the information known at the time of this document. It does not include unexpected services or complications. If you are billed for $400 or more above this estimate, you have the right to dispute the bill.

Dispute Process: If you are billed significantly more than this estimate:

• Contact our office to review the bill and discuss possible adjustments or financial assistance.
• You may initiate a dispute resolution process through the U.S. Department of Health and Human Services (HHS).
  
• To begin the process, visit www.cms.gov/nosurprises or call 1-800-985-3059.
• The dispute must be filed within 120 days of receiving the bill and includes a $25 filing fee.
  

This estimate is not a contract. You are not obligated to receive services and may choose to decline or discontinue care at any time.

Keep a Copy
Please keep a copy of this Good Faith Estimate for your records. You may need it if you are billed more than the estimated range.