Under the US No Surprises Act & Ontario Health Privacy Framework
Notice of Good Faith Estimate & Reimbursement Architecture
This notice explains your right to a Good Faith Estimate, the current Dignity Investment fee schedule, and reimbursement documentation available after payment.
Provider Information
1. Good Faith Estimate Standard (No Surprises Act)
You have the right to receive a Good Faith Estimate explaining the total expected cost of your non-emergency health care items and services. Under federal law, health care providers must give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services upon request and before scheduling.
2. Dignity Investment Fee Schedule (Locked Through March 30, 2027)
- Comprehensive Intake Assessment (The Sovereignty Foundry): $225 USD/CAD (90 minutes)
- Individual Psychotherapy Session: $150 USD/CAD (50 minutes)
- Relationship & Polycule Therapy: $200 USD/CAD (50 minutes)
- Autonomy & Executive Coaching Masterclass: $150 USD/CAD (1 hour) / $200 USD/CAD (2 hours)
3. Approved Out-of-Network Reimbursement Policy
For all out-of-network PPO insurance plans across Pennsylvania and Ontario, we issue itemized superbills and insurance-ready invoices directly upon payment, enabling seamless self-submission for out-of-network reimbursement. Third-party administrative claim platforms have been completely decommissioned.
In Pennsylvania, in-network coverage is active for Aetna (PIN #6797426) and Highmark BCBS. In Ontario, official receipts bearing Registered Social Worker credential No. 842649 enable direct reimbursement processing through Sun Life, Manulife, Canada Life, and Desjardins.