Insurances Accepted
Aetna
Ambetter
Anthem
Blue Cross
Blue Shield
BlueCross and BlueShield
ComPsych
Humana
Medicare
MultiPlan
Optum
Oscar Health
Superior HealthPlan
TRICARE
TriWest
UMR
UnitedHealthcare
Untied Behavioral Healthcare
No Surprises Act 2021
THIS SECTION IS ONLY FOR PATIENTS WHO WISH TO PAY OUT OF POCKET (CASH) RATHER THAN USING THEIR INSURANCE. I HIGHLY RECOMMEND USING YOUR HEALTH INSURANCE TO PAY FOR SERVICES.
In 2021 Congress passed the No Surprises Act. If you pay out of pocket healthcare providers are required by law to provide an estimate of your costs. While it is not possible for a therapist to know, in advance, how many sessions may be necessary or appropriate for a given person, this breakdown provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of sessions you attend, your individual circumstances, and the type and amount of services that are provided to you.
Required Disclaimers:.
The Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is NOT a contract and does not obligate you to obtain any services from the provider, nor does it include any services rendered to you that are not identified here. 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. There may be additional items or services I may recommend as part of your care that must be scheduled or requested separately and are not reflected in this Good Faith Estimate. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. You have the right to initiate a dispute resolution process if the actual amount
charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges). 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.
For questions or more information about your right to a Good Faith Estimate or the dispute resolution process, visit https://www.cms.gov/nosurprises/consumers or call 1- 800-985-3059. The initiation of the patient-provider dispute resolution process will not adversely affect the quality of the services furnished to you. I anticipate your treatment will require weekly, 50–55-minute psychotherapy sessions throughout the next 12 months at $150.00 per session for a total of 50 weeks taking into consideration availability for both parties. For example, vacations, holidays, emergencies, sick time for an estimated total of $150.00 x 50 weeks. The fee for a 50-55-minute (psychotherapy) session (in person or via telehealth) is $150.00. Based on a fee of $150.00 per session, the following are expected charges:
Number of Weeks
Total estimated charges:
1 session per week: $150.00
2 sessions per week: $300.00
13 Weeks of Service
(Approx. 3 months)
1 session per week: $1950.00
2 sessions per week: $3900.00
26 Weeks of Service
(Approx. 6 months)
1 session per week: $3900.00
2 sessions per week: $7800.00
39 Weeks of Service
(Approx. 9 months)
1 session per week: $5850.00
2 sessions per week: $$11700.00
52 Weeks of Service
(Approx. 12 Months)
1 session per week: $7800.00
2 sessions per week: $15600.00
This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with your therapist. You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time.
You are encouraged to speak with your provider at any time about any questions you may have regarding your treatment plan, or the information provided to you in this Good Faith Estimate.
If you are in services for more than 12 months, a new GFE will be provided to you at that time.