GOOD FAITH ESTIMATE NOTICE

Notice to Clients and Prospective Clients

Under federal law, health-care providers must give patients who are uninsured or choose to pay out of pocket for services an estimate of the expected charges for non-emergency items and services.

If you are paying privately (not using insurance), you are entitled to receive a Good Faith Estimate of the total expected cost of psychotherapy services. Please see below for an explanation of the cost of psychotherapy.

The fee for a 50 minute individual / family psychotherapy visit (in person or via telehealth) varies by provider, ranging from $150 to $250. Longer appointments will be prorated to a higher rate. If you have any uncertainty about the rate your provider charges, please consult with them.

Most patients will attend one therapy visit per week, but the frequency of psychotherapy visits that are appropriate in your case may be more or less than once per week, depending upon your needs. The frequency of visits and additional services (e.g. coordination of care with additional providers, collaboration with additional members of the patient's’ family) will contribute to the overall cost of treatment, and will be based on a collaborative discussion between provider and patient.

Here are some examples of what you could expect to pay per session for services:

• Initial Intake Appointment (90791): $250 per 50-minute session

• Psychotherapy, per appointment (90834, & 90837, with the add-on code of 95 for telehealth services): $250 per 50-minute session

• Family Psychotherapy, per appointment (90846 & 90847): $250 per 50-minute session

• Coordination of care with other providers / support staff / family members (not reimbursable by insurance): prorated if longer than courtesy 15-minute duration (e.g. $125 for 25-minute meeting)

To learn more about the No Surprises Act, please visit www.cms.gov.