To All Clients: In compliance with the No Surprises Act that goes into effect January 1, 2022, all healthcare providers are required to notify clients of their Federal rights and protections against “surprise billing.” This Act requires that we notify you of your federally protected rights to receive a notification when services are rendered by an out-of-network provider, if a client is uninsured, or if a client elects not to use their insurance.
Additionally, we are required to provide you with a Good Faith Estimate of the cost of services.
It is difficult to determine the true length of treatment for mental health care, and each client has a right to decide how long they would like to participate in mental health care. Therefore, below you will find a fee schedule for the services typically offered by your therapist, and we will collaborate with you on a regular basis to determine how many sessions you may need.
Fees Vary upon amount of time in session and type of session. There will be an initial evaluation and planning session that is a 1 per year session. After that initial session you will be seen for 60 min, 1 per week sessions, depending upon your needs.
Fees may be paid in part or in whole by your insurance company. Co Pays and Deductibles are your responsibility. Scholarships are available based on needs/requests.
Fees are listed below:
1) 90791 INTAKE Psychiatric diagnostic evaluation and treatment planning $180.00
2) 90837 Psychotherapy, 60 minutes HO (53 plus min) with patient and/or family member $150.00
3) 90847 Family psychotherapy (conjoint psychotherapy) (with patient present) 50 MIN. $150.00
It is a Federal requirement that we have each client sign this form to begin/resume treatment. You will sign and date the Good Faith Estimate at time of the first intake session. If you have any questions, please don’t hesitate to contact me.