Signed in as:
filler@godaddy.com
Good Faith Estimate
Good Faith Estimate Policy Review
Effective January 1, 2022, laws regulating patient care have been updated to include the “No Surprises” act, which requires a wide variety of providers to give current and potential future clients a “Good Faith Estimate” (GFE) on the cost of treatment. Below you will find a summary of this requirement.
Effective January 1, 2022, a provider must furnish a self-pay patient with the notice and GFE prior to all scheduled services or by request if the patient is shopping for care (and not yet at the point of scheduling). This includes, but is not limited to, office visits, therapy, and diagnostic tests
Who qualifies as a self-pay patient?
A provider’s duty to provide notice and a GFE applies to self-pay patients, i.e., an individual who (1) does not have benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, federal healthcare program, or a health benefits plan; or (2) chooses not to use his or her coverage benefit for the item or service.
Estimated Costs:
Below reflects our current session fees. However, you will also be given a personalized Good Faith Estimate to sign before your appointment. The frequency with which clients are seen, and the duration of time in which they are seen, is dependent on client need. The examples are for illustrative purposes only and are not specific to you or your treatment. Instead, they are meant to show the variation of cost over the course of a year.
You may also qualify for a reduced rate. Please, contact us to get a personalized Good Faith Estimate.
Good Faith Billing
Billing Overview
Intake/Diagnostic Evaluation, 90791 $250
Psychotherapy-60 Minutes, 90837 $200
Psychotherapy-45 Minutes, 90834 $175
Psychotherapy-30 Minutes, 90832 $150
Psychotherapy with Family (45-60 minutes), 90846/47
$225
Group Therapy-60 Minutes, 90853 $40
For example, if you were seen by a clinician for an intake and then every week for the rest of the year for 60-minute sessions, your total cost would be $8450 (51 sessions at $200 plus the intake for $250).
*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. 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 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 the 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 https://www.cms.gov/nosurprises or call HHS at (800) 368-1019. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit https://www.cms.gov/nosurprises or call (800) 368-1019.
Always keep a copy of your Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.
