Good Faith Estimate
The "No Surprises Act" requires health care providers (including mental health therapists) to render a "Good Faith Estimate" (GFE) for private pay care. The GFE works to show the cost of services that are reasonably expected for your health care needs. This GFE does not include any unknown or unexpected costs that may arise during treatment, nor does it include any services rendered to you that are not identified here.
The total estimated cost provided is based on an estimated number of sessions throughout the current year; however, the amount of sessions could vary depending on what we discuss / decide in therapy. You are not obligated to these sessions - I am simply required to provide my clients with an amount they may pay if they continue services with me throughout the year. While it is not possible for us to know in advance how many psychotherapy sessions may be necessary or appropriate, 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 you receive.
This GFE is not intended to serve as a recommendation for treatment or a prediction for how many psychotherapy visits you may attend. The number of visits that are appropriate for your care and the estimated cost for those services depend on your individual needs. Some clients start out with frequent sessions, approximately one per week, and then move to biweekly sessions. Other clients will initially start with one psychotherapy visit every two weeks, then move to one session monthly. The frequency of psychotherapy visits that are appropriate in your case may be more or less, depending on your individual needs.
Examples of therapy costs (based on my stated fees - see the Therapy Services & Prices tab):
Initial Intake session, followed by weekly visits for 2 months, biweekly visit for 3 months, then monthly visits for 3 months would total $1740 over approximately 8 months. The cost breakdown is as follows:
Intake session = $125,
weekly sessions (8 x $95) = $760,
biweekly sessions (6 x $95) = $570,
monthly sessions (3 x $95) = $285
Total: $1740 (18 sessions)
Initial Intake session, followed by biweekly visits for 4 months, then monthly visits for 2 months would total $1075 over approximately 6 months. The cost breakdown is as follows:
Intake session = $125,
biweekly sessions (8 x $95) = $760,
monthly sessions (2 x $95) = $190
Total: $1075 (11 sessions)
Initial Intake session, followed by weekly visits for 3 months, biweekly visit for 4 months, then monthly visits for 3 months would total $2310 over approximately 10 months. The cost breakdown is as follows:
Intake session = $125,
weekly sessions (12 x $95) = $1140,
biweekly sessions (8 x $95) = $760,
monthly sessions (3 x $95) = $285
Total: $2310 (24 sessions)
These estimates are based on standard 60-minute sessions (other than the Intake session). If you attend therapy for a longer or shorter period or your session length differs, your total estimated charges will change so please calculate accordingly.
You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time. Also, you have a right to initiate a dispute resolution process if the actual amount charged substantially exceeds the estimated charges. Please feel free to ask any questions you may have regarding the information provided to you in this Good Faith Estimate.
