I understand that you may be feeling anxious, upset or in turmoil when you enter into therapy. This session is meant to get to know each other and get a sense of what therapy is all about. I will answer any questions you have. I hope to get a good understanding of why you are seeking therapy in this initial meeting.
$150.00 individual session
GOOD FAITH ESTIMATE
In compliance with the No Surprise Act, we will provide a Good Faith Estimate of costs for clients who are uninsured or those who choose not to use their insurance.
Under the No Surprises Act (H.R. 133 – which will go into effect on January 1, 2022), health care providers need to give clients or patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.
This 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 based on information known at the time the estimate was created.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes (under the law/when applicable) related costs like medical tests, prescription drugs, equipment, and hospital fees
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
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute 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 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.
Make sure your health care provider gives you a Good Faith Estimate within the following timelines:
• If the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling;
• If the service is scheduled at least 10 business days before the appointment date, no later than three business days after the date of scheduling; or
• If the uninsured or self-pay patient requests a good faith estimate (without scheduling the service), no later than three business days after the date of the request. A new good faith estimate must be provided, within the specified time frames if the patient reschedules the requested item or service.
This is the public disclosure of the “Good Faith Estimate” Note: A Good Faith Estimate is for your awareness only. It does NOT involve you needing to make any type of commitment.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 800-985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059. Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.
If you have questions or concerns, please reach out, a Good Faith Estimate will be provided along with standard intake forms.
I do accept some insurance plans. Please let me know if you have insurance when you connect with me and I can let you know if I am a participating provider. I expect payment at the time of visit. I will provide a receipt for insurance reimbursement upon request. To determine if you have mental health coverage, the first thing you should do is check with your insurance carrier. Check your coverage carefully and find the answers to the following questions:
- Do I have mental health benefits?
- What is my deductible and has it been met?
- How many sessions per calendar year does my plan cover?
- How much does my plan cover for an out-of-network provider?
- What is the coverage amount per therapy session?
- If my psychological problem is based on medical necessity, does the coverage more significant?
Cash, check and all major credit cards accepted for payment. Payment is expected at the time of service.
If you do not show up for your scheduled therapy appointment, and you have not notified us at least 24 hours in advance, you will be required to pay the full cost of the session.
Any Other Questions
Please contact me for any additional questions you may have. I look forward to hearing from you!