Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one (1) business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
As per Claudia's Practice Policies, regardless of diagnoses or length of services, the standard fees for in-person rendered at the address above, and telebehavioral health therapy services are as follows:
90791- Initial intake session consisting of 50-60 minutes is $175.00
+90838- 110- 120 minutes for intensive session is $300.00
90837- 50-60 minute session is $160.00 (Effective March 1st, 2023)
90834- 40-50 minute session is $130.00
90832- 30 minute session is $100.00
90847- 50-60 minute couples/family session is $200.00
15 minute documentation fee is $25
Non-Therapeutic/Other Fees:
Late cancelation/no show fee $160 (Effective March 1st, 2023)
Court fees are documented in the Practice Policies
Your annual estimated costs for services will vary based on frequency of sessions, length of time in treatment, and commitment to treatment.
Annual costs can vary for example:
Twice weekly sessions of $160 for 52 and the one-time intake session of $175, would average out $16,815.
Weekly sessions for 52 weeks and the onetime intake $175 would average $8,495 per year.
Bi-weekly sessions of $160 and the one time intake of $175 wouild average to $4,175 per year.
Thsee estimate do not include late/no show fees.
These estimates do not include fees for court appearances should they be required.
Disclaimer
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.
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.
The good faith estimate is only an estimate and that actual charges may differ, you as the patient have the right to initiate the patient-provider dispute resolution process if the actual bill charges substantially exceed the expected charges in the good faith estimate, and that the good faith estimate is not a contract and does not obligate, you, the patient to obtain the items or services from any of the providers identified in the good faith estimate.
If you are billed for more than this Good Faith Estimate, you have the right to 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.
To learn more and get a form to start the process, go to 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 www.cms.gov/nosurprises or call (800) 368-1019.
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.