It is important to me that you understand your financial responsibilities regarding our appointments so I wanted to provide you with the following information.
FINANCIAL/INSURANCE I will bill your insurance company if you wish. All payments and/or co-payments are due at the time of the appointment. If you have not met your deductible, the full fee is due at each session until the deductible is satisfied. If your insurance company denies payment or does not cover counseling, we request that you pay the balance due at that time. We accept personal checks, cash, Visa, and MasterCard. A returned check fee of $35.00 will be charged.
|Initial Assessment & Diagnosis (50 minutes)||$195.00 or co-pay amount|
|Individual Therapy Session (50 minutes)||$180.00 or co-pay amount|
Cancellations There is no charge for cancellations made at least 24 hours in advance of your appointment time.
|Late cancellation (less than 24 hours notice)|| $180 or insurance contracted charge
I take BCBS and Aetna. I can also provide a super bill that you can submit to your insurance and they may provide Out Of Network payment.
Services may be covered in full or in part by your health insurance or employee benefit plan. Please check your coverage carefully by asking the following questions:
- Do I have mental health insurance benefits?
- What is my deductible and has it been met?
- How many sessions per year does my health insurance cover?
- What is the coverage amount per therapy session?
- Is approval required from my primary care physician?
Good Faith Estimate
You are entitled to receive a Good Faith Estimate of what the charges could be for psychotherapy services provided to you. While it is not possible for a psychotherapist to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual circumstances, and the type and amount of services that are provided to you.
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. This estimate is not a contract and does not obligate you to obtain any services from the provider(s) listed, nor does it include any services rendered to you that are not identified here.
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).
For questions or more information about your right to a Good Faith Estimate or the dispute 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.
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.
Questions? Please contact me for further information at [email protected]..