Good Faith Estimate Policy

About Your Right To Receive A Good Faith Estimate Of Expected Charges

Under the law, as health care providers, we will give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

This estimate is called a "Good Faith Estimate" and explains how much your Therapy sessions will cost. Here are a few key things you should know about your Good Faith Estimate:

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
  • You may ensure that we give you a Good Faith Estimate in writing before your Therapy, Couples Therapy, Training & Consulting services. You can also ask us for a Good Faith Estimate prior to scheduling.
  • If you receive a bill that is $400 more than your Good Faith Estimate, you can dispute the bill.
  • It's recommended that you save a copy of your Good Faith Estimate for your records.

For further information, visit www.cms.gov/nosurprises or call 800-985-3059.

Additional Information from the practice

Please Note:

Diagnosis and frequency of clinical care may change after the initial intake period; these changes can affect costs and decrease the accuracy of this estimate.

GFE total dollar amount on the form you will be sent is based on:

  • Your consistent attendance of (weekly/biweekly/monthly) scheduled appointments through the end of the calendar year at your current dollar rate. For example, if your appointments are weekly they would be your ($ rate) x (52 weeks) = Total $ GFE amount
  • Adjustment to the frequency of appointments can be a necessary part of psychotherapy treatment. If your frequency of attendance of appointments changes, you may re-calculate or request a new GFE

This GFE total dollar amount above is also based on 2022-2023 Rates:

  • Individual Psychotherapy $150-$165 / hour
  • Couples Psychotherapy $150-$185 / hour

The following services are not included in the GFE because these services are provided by request and can affect the accuracy of the above rate list:

Clinical Consultation
Administrative Paperwork Requests
Other services

Rates:
< 15 minutes of work - free, no cost
=> 16 minutes of work - Pro-rated to clinical rate

PLEASE NOTE:

  • Rates are reviewed & adjusted by September 1st of each year based on cost-of-living increases as well as other factors
  • During treatment, you may determine a need for additional services. The request of these services can affect the accuracy of the above GFE.